1. Chapter 19 Female Reproductive System
International Classification of Diseases Tenth Revision Procedure Coding System (ICD-10-PCS): An Applied Approach 2012 Edition
Chapter 19
Female Reproductive System

2. Functions of the Reproductive Systems
Both male and female
Produce offspring to maintain the species
Female reproductive system – Body System U

3. Functions of the Female Reproductive System
Produce gametes cell
-Eggs or ova
Transport and sustain these cells
Nurture developing offspring
Produce hormones
Ovary is the primary reproductive organ

4. Organization of the Female Reproductive System
Ovaries
Uterine supporting structures
Fallopian tubes
Uterus
Endometrium
Cervix
Cul-de-sac
Vagina
Clitoris
Hymen
Vestibular glands
Vulva
Ova

5. Ovary Ovary -Small solid structure on either side of the uterus
-Held in place by peritoneal ligaments
-Produce ova in an ovarian follicle
-Egg is released and follicle enlarges and becomes a corpus luteum
If egg is fertilized corpus luteum continues to create hormones

6. Fertilization
Released egg caught by fimbriae at the end of fallopian tube
Transported towards the uterus
If fertilized – classified as Products of Conception by ICD-10-PCS
Fertilized egg implants in the endometrium of the uterus and develops into a fetus
-See Chapter 20

7. Uterus Uterus -Muscular structure in pelvic cavity
-Held in place by the uterine supporting structures
Broad ligaments (paired)
Uterosacral ligaments (paired)
Posterior ligament (single)
Anterior ligament (single)
Round ligament (paired)

8. Uterus (continued)
Cul-de-sac – blind pouch also known as rectouterine pouch
Vestibular glands
-Skene’s glands
-Bartholin glands
Endometrium – inner lining of the uterus
See Figure 19.1

9. Vulva External genitalia -Mons pubis -Labia majora -Labia minora
-Clitoris
-Urethral and vaginal openings
-Vestibular glands
-Hymen
-See Figure 19.2

10. Common Root Operations
Sterilization
-Occlusion – using sutures, clips or rings
-Destruction – burning the fallopian tubes
Division of the tubular body part prior to closing is an integral part of the procedure
-Resection – complete removal of the fallopian tubes
Reversal of a tubal ligation – tubotubal anastomoses - Repair

11. Colporrhaphy Colporrhaphy – repair of ruptured vagina
-Anterior – front of the vagina, involvement with bladder
-Posterior – back of the vagina, involvement with rectum
-Either may include fistulas between organs
-Repair is the root operation
-Supplement if mesh is used

12. Vaginal Procedures
Colpocleisis – secure vaginal walls together internally with obliteration of the vaginal opening
-Occlusion is the root operation if totally closed
Colpopexy and/or ureteropexy-fixation and maintain vaginal introitus
-Reposition

13. Cervical Conization
Cervical conization – cold knife or cone biopsy – used to treat early stages of cervical cancer
-Small cone-shaped sample is removed from the cervix and examined under a microscope
-Biopsy can be the treatment if all is removed
-Can also be performed using loop electrode-LEEP
-Excision is the root operation
X for diagnostic in the qualifier if this is a biopsy

14. Common Procedures
Cervical cerclage – strong suture or wire around the cervix making the opening smaller and stronger
-Restriction is the root operation
-Coded in Female Reproductive as performed on the pregnant female
Endometrial ablation via thermal or cryoablation
-Destruction is the root operation
Endometrial biopsy – Extraction with X for the qualifier

15. Other Procedures Marsupialization of the Bartholin’s gland cyst
-Drainage of cyst
-Excision of sac
-Both procedures can be coded if performed
Transplantation of the ovary
See Table 19.1

16. Body Part Values-Hysterectomy
Total hysterectomy = removal of the uterus and cervix
Subtotal hysterectomy = only the uterus is removed, cervix left intact
Resection is the root operation as all of the body part is removed
TAH – BSO requires 4 codes
- Cervix Bilateral Fallopian tubes
- Uterus Bilateral Ovaries

17. Bilateral Body Parts
Body part values for individual ovaries and fallopian tubes as well as bilateral
See Coding guideline B4.3
Combined body part values in some root operations that involve devices or inspection
-Uterus and cervix
-Vagina and cul de sac
See Table 19.2

18. Approaches
F – Via natural of artificial opening with percutaneous endoscopic assistance
-Laparoscopic ports and visualizing instruments through the skin to assist with resection, vaginally
-Only used in the Female Reproductive System
-Only used with the Resection root operation
-Only for body parts ovaries, fallopian tubes and uterus
All seven approaches are used, See Table 19.3

19. Devices G – Intraluminal Device –Pessary H – Contraceptive Device
-see Figure 1.7
-Appliance of varied form, introduced into the vagina to support the uterus or correct displacement or prolapse
-Fitted by provider
H – Contraceptive Device
-Usually means IUD
See Table 19.4

20. Qualifiers
Transplantation of ovary – qualifiers for the source of the transplant
-Allogeneic
-Syngeneic
-Zooplastic
X - Diagnostic
Z – No Qualifier
See Table 19.5