Re: Codes for NFP (Leukorrhea explained)

[Guest guest]

With all due respect for your experience, hyfrecation, cryotherapy or chemical cautery may have the net effect of decreasing discharge, but at the cost of destroying the very cells which facilitate female cervical fertility. Cervical eversion or ectropion is the response of (mucus-producing) columnar epithelium to a stimulus: excess estradiol (iatrogenic or the natural response to puberty and pregancy), and inflammation, to the relatively hostile enviroment of the vagina. The squamous epithelium, which normally lines the vagina and other mucus membranes, advances over this everted glandular epithelium as a protective mechanism, thus advancing the squamocolumnar junction into the endocervical canal, resulting in "squamous metaplasia." Ablative therapies such as the ones described above simply make it more difficult to evaluate the transformation zone colposcopically, if warranted.

We can split hairs indefinitely about the effect of drugs, pathogens, irritants and carcinogens on the consistency and characteristics of cervical mucus. The point I am trying to make is that the cervix and vagina are a perfect barometer of ovarian function when one simply observes whether there is a changing or unchanging pattern of discharge.(Brown) Since a recent Italian study indicates that mean time to immune clearance of even potentially carcinogenic HPV viral types in women under the age of 28 is 18-24 months, destructive procedures are unwarranted for purposes of "treating" leukorrhea.

mm

Re: Codes for NFP teaching

Yes- I know the ICD9 codes, but they are diagnosis codes and we need to have "Procedure" code, "CPT" to go along with it to get re-imbursed by third party payers, aka insurance companies.

I was just wondering if others are using the same E & M / CPT codes for teaching? I use Dx codes for s/s together with the E & M codes for medical management and chart reviews and teaching, but if they are just in for follow-ups and have no medical indications, it is a little harder to justify the charges (should a question come up with insurance companies).

Codes for NFP teaching

Hi

Are any of you coding for NFP instruction with any CPT codes other than the

time based ie 99205 for 1 hour new pt, 99215 for return visits?

Working on a budget forecast and need to figure in "allowables" for

re-imbursement, (that we probably won't get) for grant writing purposes wehope...

Sandrock, CNM

Holy Family Services

www.holyfamilybirthcenter.com

__________________________________________________________

________

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[Guest guest]

Thank you for the explanation Dr.

----very helpful once again!

Sheila St.

Executive Director

California Association of Natural Family Planning

1217 Tyler St.

Salinas, Ca. 93906

1-877-33-CANFP

www.canfp.org

From:

nfpprofessionals [mailto:nfpprofessionals ] On Behalf Of obdoc2000@...

Sent: Wednesday, February 20, 2008

2:36 PM

To:

nfpprofessionals

Subject: Re:

Codes for NFP (Leukorrhea explained)

With

all due respect for your experience, hyfrecation, cryotherapy or chemical

cautery may have the net effect of decreasing discharge, but at the cost of

destroying the very cells which facilitate female cervical fertility. Cervical

eversion or ectropion is the response of (mucus-producing) columnar epithelium

to a stimulus: excess estradiol (iatrogenic or the natural response to puberty

and pregancy), and inflammation, to the relatively hostile enviroment of the

vagina. The squamous epithelium, which normally lines the vagina and other

mucus membranes, advances over this everted glandular epithelium as a

protective mechanism, thus advancing the squamocolumnar junction into the

endocervical canal, resulting in " squamous metaplasia. " Ablative therapies

such as the ones described above simply make it more difficult to evaluate the

transformation zone colposcopically, if warranted.

We can split hairs indefinitely about the effect of drugs, pathogens, irritants

and carcinogens on the consistency and characteristics of cervical mucus. The

point I am trying to make is that the cervix and vagina are a perfect barometer

of ovarian function when one simply observes whether there is a changing or

unchanging pattern of discharge.(Brown) Since a recent Italian study indicates

that mean time to immune clearance of even potentially carcinogenic HPV viral

types in women under the age of 28 is 18-24 months, destructive procedures are

unwarranted for purposes of " treating " leukorrhea.

mm

Re: Codes for NFP teaching

Yes- I know the ICD9 codes, but they are diagnosis

codes and we need to have " Procedure " code, " CPT " to go

along with it to get re-imbursed by third party payers, aka insurance

companies.

I was just wondering if others are using the same E & M / CPT codes for

teaching? I use Dx codes for s/s together with the E & M codes for medical

management and chart reviews and teaching, but if they are just in for

follow-ups and have no medical indications, it is a little harder to justify

the charges (should a question come up with insurance companies).

Codes for NFP teaching

Hi

Are any of you coding for NFP instruction with any CPT codes other than the

time based ie 99205 for 1 hour new pt, 99215 for return visits?

Working on a budget forecast and need to figure in " allowables " for

re-imbursement, (that we probably won't get) for grant writing purposes wehope...

Sandrock, CNM

Holy Family Services

www.holyfamilybirthcenter.com

__________________________________________________________

________

Looking for last minute shopping deals?

Find them fast with Yahoo! Search.

http://tools.search.yahoo.com/newsearch/category.php?category=shopping

[Guest guest]

Dear Dr. , What would you recommend instead of hyfrecation, cryotherapy or chemical cautery for juvenile ectropian (not associated with infection) when the discharge is excessive? Client is 16 years old. Thanks,Kathy Re: Codes for NFP (Leukorrhea explained)

With all due respect for your experience, hyfrecation, cryotherapy or chemical cautery may have the net effect of decreasing discharge, but at the cost of destroying the very cells which facilitate female cervical fertility. Cervical eversion or ectropion is the response of (mucus-producing) columnar epithelium to a stimulus: excess estradiol (iatrogenic or the natural response to puberty and pregancy), and inflammation, to the relatively hostile enviroment of the vagina. The squamous epithelium, which normally lines the vagina and other mucus membranes, advances over this everted glandular epithelium as a protective mechanism, thus advancing the squamocolumnar junction into the endocervical canal, resulting in "squamous metaplasia." Ablative therapies such as the ones described above simply make it more difficult to evaluate the transformation zone colposcopically, if warranted.

We can split hairs indefinitely about the effect of drugs, pathogens, irritants and carcinogens on the consistency and characteristics of cervical mucus. The point I am trying to make is that the cervix and vagina are a perfect barometer of ovarian function when one simply observes whether there is a changing or unchanging pattern of discharge.(Brown) Since a recent Italian study indicates that mean time to immune clearance of even potentially carcinogenic HPV viral types in women under the age of 28 is 18-24 months, destructive procedures are unwarranted for purposes of "treating" leukorrhea.

mm

Kathy Schmugge

Family Life Coordinator

Diocese of ton