Ob-Gyn Coding Alert

Receiving a denial because of an incorrect diagnosis code can be costly, time consuming, and downright frustrating. But ensuring that the diagnosis code for female genital organ pain or bleeding is correct can be difficult. This difficulty arises from the fact that often these female problems are not attributable to any specific disease processes and require the coding of signs and symptoms. However, instead of turning to the special section in the ICD-9-CM for symptoms (sections 780-799), ob/gyn coders need to use a special section that covers symptoms and disorders of the female genital organs and the natural functions of menstruation and menopause (codes 625-627). For correct selection these codes require a sound understanding of terminology and clinical manifestations. With the clinical help of womens health nurse practitioner Linda Dominguez, RN-C, from Albuquerque, NM, this article reviews each of the codes and is designed to assist the ob/gyn coder in choosing correct codes the first time through.

Pain and Other Symptoms

The codes in section 625 (pain and other symptoms associated with female genital organs) include everything from painful intercourse to female stress incontinence.

625.0: Dyspareunia is the medical name for painful intercourse. This code covers painful intercourse at any age and pain that occurs during or after intercourse. The pain may be felt deep in the pelvic region, in the vagina itself, or superficially. Both physical and/or psychological factors can contribute to or cause dyspareunia. For psychogenic dyspareunia, code 302.76 (psychosexual dysfunction with functional dyspareunia).

Note: It is not recommended that ob/gyn practices use the codes for psychogenic disorders because many payers will not pay for the mental disorder codes unless you are a mental health care provider.

625.1: Vaginismus is the involuntary spasm of the muscles surrounding the vaginal opening. This spasm can cause the vagina to close so tightly that it is impossible for intercourse or the insertion of tampons or medical instruments. This disorder is also called colpospasm or vulvismus. If the cause is psychogenic, use code 306.51 (psychogenic vaginismus).

625.2: Mittelschmerz is a German term that simply means middle pain. This code is for abdominal pain occurring from the site of ovulation and at time of ovulation or in the middle of the menstrual cycle.

625.3: Dysmenorrhea is a commonly used code for painful menstruation, including cramps. Again, if the painful menstruation is of a psychogenic nature, use 306.52 (psychogenic dysmenorrhea).

625.4: Premenstrual tension syndrome. This code is to be used for premenstrual symptoms, including headaches. The term molimen in the code description means the effort to establish normal menstrual flow.

625.5: Pelvic congestion syndrome (also referred to as Taylors syndrome or congestion fibrosis syndrome) refers to a complex of symptoms caused by abnormalities within the ovarian veins. In pelvic [...]