# excision of vaginal fibroid



## JLM322 (Apr 26, 2011)

How would you code an excision of 5 cm vaginal fibroid? Would it be CPT code 11426? What diagnosis? ICD-9 code 221.1?


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## MJ4ever (Apr 26, 2011)

Dx 239.5 Unless you have a lab result stating it is a benign vaginal fibroid (221.1).

CPT 57135 Excision of Vaginal cyst or tumor.

I double checked the index for excision of neoplasms in the CPT book. Neoplastic Growth redirects to Tumor.

Hope this helps.


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## preserene (Apr 26, 2011)

Yes MJ,greatly appreciate your input. You are right with 57135- excision of vaginal tumor.
Yet,  I would like to have some more info to be more specific- Was it a primary vaginal fibroid which is extremely very rare or pedunculated submucous fibroid from uterus or hanging cervical fibroid? If primary vaginal fibroid- 57135. If from pedunculated fibroid from uterus or cervix- I would like to assign from uterine myomas- 58145, 0R 58146.

When it is documented Fibroid by physician, I would go for benign leomyoma only. Basically fibroids are benign, primarily from uterine smooth tissue. It is rarely seen as primary vaginal fibroid. Since we do not have a diagnosis code for vaginal fibroid, I would prefer 218.9 by its nature, terminology and histological diagnosis and its terminology rather than 221.2, 221.2 is anatomically preferable, though. Well, it is a good debatable code though.
But I would not go for 239 series unless and otherwise proved pathologically. Transformation of fibroid into malignancy not common.
Thank you for giving an opportunity for the insight of this rare event.


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## MJ4ever (Apr 27, 2011)

JLM322 said:


> How would you code an excision of 5 cm vaginal fibroid? Would it be CPT code 11426? What diagnosis? ICD-9 code 221.1?



Hi JLM
I worked the codes through 3M and also came up with 221.1 as you did instead of the 239code. Last night I was just looking through my books...
I apologize for the inconvenience.
The CPT was correct though : )

Have a great day.


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## JLM322 (Apr 28, 2011)

Thank you so much! I searched the CPT book and couldn't find a code in the Female genital System section. Now I see that I could have found it in the index under excision, cyst, vagina. Good thinking. Yes, it was in the vagina. She had a hysterectomy. Such an unusual circumstance.

The doctor's diagnosis was vaginal fibroid and pathology states "leiomyoma." Do you still agree on 221.1?

Joanna


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## MJ4ever (Apr 28, 2011)

I still choose with 221.1.
The following site states to code the fibroid by its location.
None of the 218.x dx match the site of vagina:

http://codingnews.inhealthcare.com/coding-challenge/medical-coders-focus-on-fibroid-diagnosis/


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## preserene (Apr 28, 2011)

We are given an opportunity for research and ponder because it had not been existing in coding or  clinical nomenclature for so long because of its non existence before/extreme rarity/or not in practical experience.
Well it matches the clinical, structural, and histopathological. When it is documented as Fibroid and histopathologically if  it  is for sure a fibroid/ leomyoma. Fibroid is of the typical uterine tissue structure   and has an unique macroscopic, cut section and histological finding(which vaginal tissues do not share). I am of openion for the more specificity of its macroscopic,structural & histo-pathological findings and its original tissue nomenclature. I have not come across one vaginal fibroid in my forty yrs of experience. I feel like it is better to code closer to its group/kins more of clinical identity. Well you may be right in placing it along with vaginal benign tumor at the end of the day with the carrier choice favoring the same diagnosis.
For eg). Endometriosis is structurally and typically from the uterine tissue. But it happens to occur /carried to other places/organs, which are structurally different from uterine tissues. Yet they are grouped under Endometriosis-sub groups as Uterine endometriosis, Pelvic Endometriosis, Ovarian Endometriosis etc. There are about 32 groups of ENDOMETRIOSIS. *They are all categorized under one head of 617 series*.

I still lean towards 218.xx more so for .9 forth digit as an option, for its non specificity into the uterine site, yet it is LEOMYOMA/FIBROID. 
May be one day, I am sure, this (VAGINAL FIBROID) will be included along with its kins /relatives of fibroid in our coding nomenclature with a separate fourth or fifth digit, if not in immediate future!!!???
Thank you for presenting a great topic!


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## MJ4ever (Apr 29, 2011)

Hello Preserene,

Maybe the situation was like in the picture on this site, where a fibroid started in the uterus and moved to the vagina. And that would make most sense then to code 218.x : )

http://medical-dictionary.thefreedictionary.com/leiomyoma

If, as you describe, you haven't seen a vaginal leiyoma in 40 years, I would think this is what may have happened here then (?).

I was wondering. My daughter's syndrome came to mind, where she can develop cardiac fibromas. And fibromas being similar to a leiyomas, I would hope it is not coded by it's histology as a uterine fibroma lol. She can develop fibromas all over her body and these would be coded as 218.x for all ? Haven't looked these dx up, so I who knows, maybe they would be coded 218.x  : )

Thanks for your feedback Preserene.


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## preserene (May 1, 2011)

Histologically,  there are three types of muscle fibres: Skeletal muscles, Cardiac muscles and Smooth muscles.
Skeletal muscle fibres bear obvious striations, have many peripherally loculated nuclei, are of the same thickness throughout their length and do not branch. eg) muscles attached to the skeleton.
Cardiac muscle fibres are striated, have one or two centrally located  nuclei, branch and anastomose with other fibres, and are joined to one another by intercalated discs- eg) cardiac muscles.
Smooth muscle  is intrinsic muscle of the internal organs and blood vessels. No striations are present due to the different arrangement of actin and myosinfilaments. Like cardiac muscle, smooth muscle fibres are intrinsically contractile but responsive to autonomic and hormonal stimuli. They are specialized for slow, prolonged contraction. They are generally arranged in bundles or sheets. Each fibre is fusiform in shape with a thicker central portion and tapered at both ends. The SINGLE NUCLEUS is located in the central part of the fibre. Also smooth muscles often have a cork screw shape in longitudinal section due to contraction of the muscle fibre during fixation.
One distinguishing physiological feature of smooth muscle is its ability to secrete connective tissue matrix. In the walls of blood vessels and the uterus in particular, smooth muscle fibres secrete large amount of collagen and elastin.
To be more brief, smooth muscle fibres (eg) of the UTERUS are fusiform with taped ends, have a single centrally located nucleus and do not exhibit striations.
Cardiac fibromas could resemble a uterine fibroid in naked eye examination. Histologically the tumor, benign though, consists of fibrous tissue of various degree of cellularity in different areas.
The smooth muscles of uterine fibroid tends to die out with the passage of time.
I hope this gives us a clue how fibroid uterus is different from cardiac fibromas and why they can not interchange in their occurrence.
Thank you


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## MJ4ever (May 3, 2011)

Great lesson.
I really appreciate it : )
Thank you


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