Wiki Irregular bleeding with Nexplanon

[dbolivar1]

Patient was seen for "irregular menstrual bleeding status post Nexplanon insertion."

Nexplanon was placed on 6/7/2022. Since that time she has had a lot of spotting and irregular bleeding that ranges from light to heavy on most days. This is quite bothersome for her and would like to try something to help with the bleeding.

Assessment / counseling / education: Reassured the patient that this can be quite normal with the implant. As this is bothersome, as this is bothersome for her, we will treat with 3 months of cOCPs to regulate the bleeding. Advised to follow-up after this timeframe if the bleeding continues.

Would I use N93.9-Abnormal uterine and vaginal bleeding, z97.5- Presence of other specific devices and Z30.011- encounter for initial prescription of contractive.

Thank you!

 

[lgardner]

how about N93.9 and T38.5x5A - adverse effect of other estrogens and progestogens?

I think the Z30.011 is inappropriate. since pt is not being seen for the "initial prescription of contraceptive". it was prescribed (probably) before 6/7/22, if not on 6/7.

 

[nickelclaw]

Hello I would code N92.5 other specified irregular menstruation.

 

[dbolivar1]

Should I add the Z30.011 as well because the patients is going to try cOCPs to control the bleeding?

 

[lgardner]

Should I add the Z30.011 as well because the patients is going to try cOCPs to control the bleeding?

sure.
I missed that.

Hello I would code N92.5 other specified irregular menstruation.

the provider assured the pt that this can be "quite normal with the implant", that indicates to me that the bleeding is a complication of the contraceptive implant.
I would not consider this other specified irregular menstruation, unless the provider stated it, as such.

BUT, I hadn't considered that code, so I would like to hear why you think that is an appropriate code. I am, always, up for discussion and am open to learning.

 

[nickelclaw]

sure I feel that since doc stated it's normal it wouldn't be an adverse effect or complication of implant
I was basing it off of original post

"irregular menstrual bleeding status post Nexplanon insertion."

and yes the initial script dx

 

[lgardner]

sure I feel that since doc stated it's normal it wouldn't be an adverse effect or complication of implant
I was basing it off of original post

gee. I must be sleeping today.

I still think that if the bleeding is being caused by the implant, I would consider it an adverse effect. it is a, potentially, expected effect, but it is still adverse.

code adverse effect when it is caused by a "drug that has been correctly prescribed and properly administered".

I think that either code regarding the bleeding could be appropriate. if there were an easy opportunity, I would query the provider.

thanks for the discussion.