Ob-Gyn Coding Alert

You may have to wait for the pathology report.

Fibroids and polyps are similar because they're both growths, but one occurs in the endometrial lining while the other occurs in the muscle. Can you guess which one is which? Here's the answer.

Polyps are small growths on the surface of the uterine wall that are easy for the ob-gyn to remove. In other words, they are an overgrowth of the endometrial lining. They're intracavitary lesions.

Fibroids (or myomas) are larger and are usually imbedded in the smooth muscle of the uterine wall. They are almost always benign, but in rare circumstances, they can become a sarcoma (muscle cancer). These growths require more work to remove; hence the procedures associated with fibroids tend to have higher relative value units (RVUs).

Fibroids form in three main locations:

• Submucous fibroids (218.0) grow from the uterine wall toward the uterine cavity. They are also called intracavitary fibroids.
• Intramural fibroids (218.1) grow within the uterine wall (myometrium). They are also called interstitial fibroids.
• Subserous fibroids (218.2) grow outward from the uterine wall toward the abdominal cavity. They are also called subperitoneal fibroids.

If the physician does not specify the location or type of the uterine fibroid, or this information is not included in the path report following surgery, assign 218.9 (Leiomyoma of uterus, unspecified) as the diagnosis.

Important: You should report fibroids based on size, location (the fourth digit), and number.

Key strategy: Sometimes, ob-gyns may have trouble distinguishing between a small fibroid and a large polyp, but they do have different appearances and textures when visualized during the procedure. If you don't have enough to choose your ICD-9 code, you may need to wait for the pathology to return for a final diagnosis (a delay of 10 days or so).

ICD-10: Once payers start requiring ICD-10, your diagnosis codes will include numbers and letters. For example, ICD-10 2010 lists the previously mentioned fibroid codes as:

• D25.0 -- Submucous leiomyoma of uterus
• D25.1 -- Intramural leiomyoma of uterus or Interstitial leiomyoma of uterus
• D25.2 -- Subserosal leiomyoma of uterus or Subperitoneal leiomyoma of uterus
• D25.9 -- Leiomyoma of uterus, unspecified

Head to http://www.cdc.gov/nchs/icd/icd10cm.htm#10update to learn more about ICD-10.