# new coder needs help with diagnosis



## ggparker14 (Mar 4, 2011)

Need help with diagnosis for procedure: total abdominal hysterectomy

physician states as diagnosis: chronic pelvic pain unresponsive to conservative therapies.

Does anyone know if there is a diagnosis for "unresponsive to conservative therapies"?

Thanks for any help.


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## preserene (Mar 5, 2011)

Could noncompliance code V15.81 be applicable to the situation?!
Noncompliance to medical treatment - could mean on the part of the treatment modalities too I think (?!).
May be there is an E Code available; we would have to research


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## preserene (Mar 5, 2011)

Could it be psychogenic- then you could think of 307.89 and the code for site of pain as the primary code; for (eg)in female, pelvic pain 625.8 as the first. But would like to know the primary indication for Hysterectomy. WAs there a diagnosis of pelvic congestion syndrome


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## preserene (Mar 6, 2011)

Chronic pelvic pain has a synonym as " Pelvic Congestion Syndrome".
Hysterectomy is reserved for patients with chronic pelvic pain unresponsive to medical or conservative. 
Pain symptoms may take weeks to months to improve- so it is chronic.
Conservative treatments mean :  Like hormonal suppression testing , non-steroidal anti- inflammatory drugs, alternate therapies like hypnosis, physical therapy, nerve block, Even treating for undiagnosed gyn. disorders, urological diseases, gastrointestinal ailments, musculocutaneous problems, psychosomatic problems could have been thought of, and initiated treatment for the same; even varicosity of the ovarian, pelvic veins, which are found to be one of the major causes, get treated with EMBOLIZATION therapy.. .  ALL THE ABOVE/SOME OF THEM FAILED,  MEANS –“ IRRESPONSIVE TO CONSERVATIVE TREATMENT.” 
WHEN THE SCENARIO GIVES SUCH  a STATUS OR CONDITION, Hysterectomy is reserved for patients with chronic pelvic pain, unresponsive to medical or conservative surgical therapy.
Why I brought this analysis is the chronic pelvic pain has the synonym as PELVIC CONGESTION SYNDROME ( WHICH IS PRONE FOR THIS IRRESPONSE TO CONSERVATIVE MANAGEMENTS, AND GETS RESERVED FOR HYSTERECTOMY).

So I would like to assign codes-  625.5 Pelvic Congestion Syndrome, and , V15.81- for noncompliance (irresponsive to medical management), if psychosomatic factor is not displayed there.


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## JulesofColorado (Mar 11, 2011)

I think you are diagnosing the patient yourself!!

"physician states as diagnosis: chronic pelvic pain unresponsive to conservative therapies."

pelvic pain is 625.9, unless you have more information not given here.

And unresponsive to conservative therapies does not mean the patient was non compliant unless the physician specifically states noncompliance!
I would use a V code for long term drug use, V58.69, unless you know the specific drug the patient has been taking.


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## ohn0disaster (Mar 11, 2011)

*Noncompliance:* The failure or refusal to comply; the failure or refusal to conform and adapt one's actions to a rule or to necessity. 

The term "noncompliance" is used in medicine particularly in regard to a patient not taking a prescribed medication or following a prescribed course of therapy.

That being said, if a patient is unresponsive to treatment, it means that the patient was given the treatment (complied with said treatment) but was found to be unresponsive (*unresponsive* - not responding to some influence or stimulus) to the treatment given.

Therefore, I do not agree with using the noncompliance V-code, as that is not the situation being described. As for the V58.69 being coded for long term drug use, "conservative therapies" does not necessarily allude to the use of a drug. It is all relative to what the doctor considers "conservative therapy". We do not have enough information posted by the person originally asking this question to code anything but the Chronic Pelvic Pain. I tried to find a code that would fit for "treatment failure" but was unable. Unless there is something more descriptive in the note, I would stick with coding Chronic Pelvic Pain.

Hope this helps!


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