Chapter 19 Female Reproductive System

1. International Classification of Diseases Tenth Revision Procedure Coding System (ICD-10-PCS): An Applied Approach2012 Edition Chapter 19 Female Reproductive System

2. Functions of the Reproductive Systems • Both male and female • Produce offspring to maintain the species • Female reproductive system – Body System U

3. Functions of the Female Reproductive System • Produce gametes cell -Eggs or ova • Transport and sustain these cells • Nurture developing offspring • Produce hormones • Ovary is the primary reproductive organ

4. Organization of the Female Reproductive System • Ovaries • Uterine supporting structures • Fallopian tubes • Uterus • Endometrium • Cervix • Cul-de-sac • Vagina • Clitoris • Hymen • Vestibular glands • Vulva • Ova

5. Ovary • Ovary -Small solid structure on either side of the uterus -Held in place by peritoneal ligaments -Produce ova in an ovarian follicle -Egg is released and follicle enlarges and becomes a corpus luteum • If egg is fertilized corpus luteum continues to create hormones

6. Fertilization • Released egg caught by fimbriae at the end of fallopian tube • Transported towards the uterus • If fertilized – classified as Products of Conception by ICD-10-PCS • Fertilized egg implants in the endometrium of the uterus and develops into a fetus -See Chapter 20

7. Uterus • Uterus -Muscular structure in pelvic cavity -Held in place by the uterine supporting structures • Broad ligaments (paired) • Uterosacral ligaments (paired) • Posterior ligament (single) • Anterior ligament (single) • Round ligament (paired)

8. Uterus (continued) • Cul-de-sac – blind pouch also known as rectouterine pouch • Vestibular glands -Skene’sglands -Bartholin glands • Endometrium – inner lining of the uterus • See Figure 19.1

9. Vulva • External genitalia -Mons pubis -Labia majora -Labia minora -Clitoris -Urethral and vaginal openings -Vestibular glands -Hymen -See Figure 19.2

10. Common Root Operations • Sterilization -Occlusion – using sutures, clips or rings -Destruction – burning the fallopian tubes • Division of the tubular body part prior to closing is an integral part of the procedure -Resection – complete removal of the fallopian tubes • Reversal of a tubal ligation – tubotubal anastomoses - Repair

11. Colporrhaphy • Colporrhaphy – repair of ruptured vagina -Anterior – front of the vagina, involvement with bladder -Posterior – back of the vagina, involvement with rectum -Either may include fistulas between organs -Repair is the root operation -Supplement if mesh is used

12. Vaginal Procedures • Colpocleisis – secure vaginal walls together internally with obliteration of the vaginal opening -Occlusion is the root operation if totally closed • Colpopexy and/or ureteropexy-fixation and maintain vaginal introitus -Reposition

13. Cervical Conization • Cervical conization – cold knife or cone biopsy – used to treat early stages of cervical cancer -Small cone-shaped sample is removed from the cervix and examined under a microscope -Biopsy can be the treatment if all is removed -Can also be performed using loop electrode-LEEP -Excision is the root operation • X for diagnostic in the qualifier if this is a biopsy

14. Common Procedures • Cervical cerclage – strong suture or wire around the cervix making the opening smaller and stronger -Restriction is the root operation -Coded in Female Reproductive as performed on the pregnant female • Endometrial ablation via thermal or cryoablation -Destruction is the root operation • Endometrial biopsy – Extraction with X for the qualifier

15. Other Procedures • Marsupialization of the Bartholin’s gland cyst -Drainage of cyst -Excision of sac -Both procedures can be coded if performed • Transplantation of the ovary • See Table 19.1

16. Body Part Values-Hysterectomy • Total hysterectomy = removal of the uterus and cervix • Subtotal hysterectomy = only the uterus is removed, cervix left intact • Resection is the root operation as all of the body part is removed • TAH – BSO requires 4 codes - Cervix - Bilateral Fallopian tubes - Uterus - Bilateral Ovaries

17. Bilateral Body Parts • Body part values for individual ovaries and fallopian tubes as well as bilateral • See Coding guideline B4.3 • Combined body part values in some root operations that involve devices or inspection -Uterus and cervix -Vagina and cul de sac • See Table 19.2

18. Approaches • F – Via natural of artificial opening with percutaneous endoscopic assistance -Laparoscopic ports and visualizing instruments through the skin to assist with resection, vaginally -Only used in the Female Reproductive System -Only used with the Resection root operation -Only for body parts ovaries, fallopian tubes and uterus • All seven approaches are used, See Table 19.3

19. Devices • G – Intraluminal Device –Pessary -see Figure 1.7 -Appliance of varied form, introduced into the vagina to support the uterus or correct displacement or prolapse -Fitted by provider • H – Contraceptive Device -Usually means IUD • See Table 19.4

20. Qualifiers • Transplantation of ovary – qualifiers for the source of the transplant -Allogeneic -Syngeneic -Zooplastic • X - Diagnostic • Z – No Qualifier • See Table 19.5