A common disorder affecting 4% to 12% of women of reproductive age, polycystic ovary syndrome (PCOS) can be treated by reducing the symptoms.

1. Polycystic Ovary Syndrome –
Diagnosis, Treatment and
Coding
A common disorder affecting 4% to 12% of
women of reproductive age, polycystic
ovary syndrome (PCOS) can be treated by
reducing the symptoms.
Outsource Strategies International
United States

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Also known as Stein–Leventhal syndrome or hyperandrogenic anovulation (HA),
polycystic ovary syndrome (PCOS) is a complex but common condition related to
hormone imbalance of the ovaries. Left untreated, this hormone imbalance can
affect everything from a woman’s menstrual cycle, to her appearance, to her ability
to have children, to her overall health. According to the Office on Women’s Health
(OWH), this health problem affects 1 in 10 women of childbearing age.
Being a condition with different manifestations, PCOS may be treated by a number
of different specialists including gynecologists, infertility specialists,
endocrinologists or even cardiologists to treat associated cardiovascular diseases.
Medical billing outsourcing companies can provide documentation support to
these specialists.
Symptoms and Diagnosis
Women with polycystic ovaries may experience a range of symptoms due to
elevated male hormone levels such as irregular periods, obesity, acne, excessive
hair growth in face and body, weight gain and trouble getting pregnant. Pregnant
women with PCOS have higher rates of miscarriage, gestational diabetes,
preeclampsia and Cesarean section (C-section).
Although the real cause of PCOS is not yet known, the condition is related to
different factors including insulin resistance, increased levels of hormones called
androgens, and an irregular menstrual cycle. Insulin resistance is when the body's
cells do not respond normally to insulin. As a result, your insulin blood levels
become higher than normal. Over time, insulin resistance can lead to type 2
diabetes. The severity of such symptoms can even lead to depression and also
increase the risk of developing heart diseases, obstructive sleep apnea, mood
disorders, and endometrial cancer particularly if the patient is overweight or obese.
Any single test cannot diagnose PCOS. To diagnose PCOS, you doctor may
recommend a physical exam; pelvic exam to check for signs of extra male
hormones; pelvic ultrasound (sonogram) to check the ovaries and the thickness of
the uterine lining and to detect ovarian cysts; or blood tests to check your androgen
hormone levels, all based on your medical history and symptoms.

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For reimbursement for tests and treatment, PCOS can be documented using the
codes
 E28 - Ovarian dysfunction
 E28.2 - Polycystic ovarian syndrome
“E28.2” codes are grouped within Diagnostic Related Group(s) such as
 742 Uterine and adnexa procedures for non-malignancy with cc/mcc
 743 Uterine and adnexa procedures for non-malignancy without cc/mcc
 760 Menstrual and other female reproductive system disorders with cc/mcc
 761 Menstrual and other female reproductive system disorders without
cc/mcc
Treatment
Though there is no cure for PCOS, the symptoms can be managed. Treatment will
be based on the symptoms present, other health problems and whether the patient
wants to become pregnant.
First-line treatment for women with PCOS includes lifestyle changes, such as diet
and exercise. Pharmacologic treatments may be used to correct metabolic
abnormalities and anovulation. The types of medicines that treat PCOS and its
symptoms include hormonal birth control tablets, anti-androgen medicines and
Insulin-sensitizing drugs (Metformin). The role of insulin resistance is often given
special attention. Insulin-sensitizing drugs such as biguanide, metformin,
pioglitazone, and rosiglitazone that are used to treat diabetes are frequently used in
the treatment of PCOS. These drugs help the body respond to insulin, reduce
androgen levels and improve ovulation. Restoring ovulation helps make menstrual
periods regular and more predictable.
Metformin inhibits hepatic glucose production through multiple effects on glucose
metabolism, and it also increases glucose uptake in peripheral tissues and reduces
fatty acid oxidation. Metformin therapy can be documented under
 Z79.4 Long term (current) use of insulin

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Surgery is recommended, only if the other options do not work. Two types of
surgical interventions to treat PCOS are - laparoscopic ovarian drilling and ovarian
wedge resection. While laparoscopic ovarian drilling uses electrocautery or a laser
to destroy parts of the ovary, through which ovulation can be triggered, an ovarian
wedge resection is the surgical removal of part of the ovary, which is thought to
help regulate periods and promote normal ovulation.
CPT codes for PCOS surgery include
 49322 Under Laparoscopic Procedures on the Abdomen, Peritoneum, and
Omentum
 58662 Under Laparoscopic Procedures on the Oviduct/Ovary
 58920 Under Excision Procedures on the Ovary
Some payers will consider 49322 bundled with 58662 for ovarian drilling.
To meet their complex coding tasks, physicians can consider medical coding
services provided by an experienced medical billing and coding company. Make
sure that the coding specialists are experienced in coding according to the current
gynecology medical coding standards.