ICD Code E28.2

ICD code E28.2 is a classification used to identify Polycystic Ovarian Syndrome (PCOS), a hormonal disorder common among women of reproductive age. This condition is characterized by irregular menstrual periods, excess androgen levels, and polycystic ovaries, which can lead to various health complications such as infertility, metabolic syndrome, and increased risk of type 2 diabetes. Proper documentation and coding of E28.2 are crucial for accurate billing and effective management of patient care within the healthcare revenue cycle.

1. Irregular Menstrual Cycles: Presence of oligomenorrhea (infrequent menstrual periods) or amenorrhea (absence of menstrual periods) is a key diagnostic criterion.

2. Hyperandrogenism: Clinical signs such as hirsutism (excessive hair growth), acne, or androgenic alopecia (hair thinning) indicate elevated levels of male hormones.

3. Polycystic Ovaries: Ultrasound evidence showing the presence of 12 or more follicles in each ovary measuring 2-9 mm in diameter, or increased ovarian volume.

4. Exclusion of Other Disorders: Rule out other conditions that can cause similar symptoms, such as congenital adrenal hyperplasia, androgen-secreting tumors, or Cushing's syndrome.

5. Insulin Resistance: Although not a formal diagnostic criterion, many patients exhibit signs of insulin resistance, such as acanthosis nigricans (darkened skin patches).

6. Obesity: While not necessary for diagnosis, obesity is commonly associated and can exacerbate symptoms.

7. Family History: A family history of PCOS or related metabolic or endocrine disorders can support the diagnosis.

8. Infertility: Difficulty in conceiving due to anovulation (lack of ovulation) is often observed.

These criteria are typically assessed using a combination of clinical evaluation, laboratory tests, and imaging studies to confirm the diagnosis.

For the ICD code E28.2, which pertains to polycystic ovarian syndrome, the relevant CPT codes that may be applicable for treatment and management include:

1. 99201-99215 - Evaluation and Management (E/M) services for new or established patients, depending on the complexity and time spent during the visit.

2. 76830 - Transvaginal ultrasound, which may be used for diagnostic purposes.

3. 82947 - Glucose; quantitative, blood (except reagent strip), which can be part of the metabolic evaluation.

4. 83036 - Hemoglobin; glycosylated (A1C), which may be used to assess insulin resistance or diabetes management.

5. 84146 - Prolactin, which can be measured to rule out other causes of menstrual irregularities.

6. 84443 - Thyroid stimulating hormone (TSH), which may be tested to evaluate thyroid function.

7. 85025 - Complete blood count (CBC) with differential, which can be part of the overall health assessment.

8. 85610 - Prothrombin time, which may be relevant if there are concerns about bleeding disorders.

9. 99241-99245 - Consultation codes for office or other outpatient consultations, if a specialist's opinion is required.

10. 58661 - Laparoscopy, surgical; with removal of adnexal structures (partial or total oophorectomy and/or salpingectomy), which might be considered in severe cases.

These CPT codes are examples of procedures and services that may be relevant in the management and treatment of conditions associated with ICD code E28.2. It's important for healthcare providers to select the appropriate codes based on the specific services rendered and the patient's clinical situation.

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