Icd 10 male partner of habitual aborter
Requires an additional E code to identify the adverse affects of therapy that caused the mucositis, such as antineoplastic or immunosuppressive drugs or radiation therapy. This code includes female genital cutting or mutilation Type IV status, the collective term for other types of mutilation that can include such things as pricking the clitoris with needles, burning or scarring the genitals, and ripping or tearing the vagina. Code Diagnostic coding just got easier if your practice includes insertion of an On-Q device for postoperative pain.SEE VIDEO BY TOPIC: Malingering Sample, DSM 5 Clinical Case Study, Diagnosis Film Clip
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Recurrent Pregnancy Loss
Aetna considers any of the following treatments experimental and investigational for recurrent pregnancy loss because they have not been shown to be effective for that indication:. If test results are positive for the same antibody on two consecutive occasions weeks apart, the patients should be treated with heparin and low-dose aspirin during her next pregnancy attempt.
An association between the luteal phase defect and recurrent pregnancy loss is controversial. If a diagnosis of luteal phase defect is sought in a woman with recurrent pregnancy loss, it should be confirmed by endometrial biopsy.
Luteal phase support with progesterone is of unproven efficacy. Couples with recurrent pregnancy loss should be tested for parenteral balanced chromosome abnormalities. Women with recurrent pregnancy loss and a uterine septum should undergo hysteroscopic evaluation and resection.
Cultures for bacteria and viruses and tests for glucose tolerance, thyroid abnormalities, antibodies to infectious agents, anti-nuclear antibodies, anti-thyroid antibodies, paternal human leukocyte antigen status, or maternal anti-parental antibodies are not beneficial and, therefore, are not recommended in the evaluation of otherwise normal women with recurrent pregnancy loss.
Couples with otherwise unexplained recurrent pregnancy loss should be counseled regarding the potential for successful pregnancy without treatment. The RCOG guidelines conclude that "the place of all other investigations including a search for newly described thrombophilic defects is unproven and such tests should only be performed in the context of research studies.
The American College of Obstetricians and Gynecologists state that tests for thrombophilias are not required as part of the evaluation of recurrent pregnancy loss, but may be considered in cases of otherwise unexplained fetal death in the 2nd or 3rd trimesters. Tests for factor V leiden, the prothrombin GA mutations, or deficiencies of protein C, protein S, or antithrombin III should be considered in cases of otherwise unexplained fetal death in the second or third trimesters.
However, the role of these heritable thrombophilias in recurrent early pregnancy loss is uncertain at present, and tests for these thrombophilias are not required as part of the evaluation. Whether antithrombotic treatment improves subsequent pregnancy outcomes in women with evidence of thrombophilia is uncertain.
Updated guidelines from the American College of Obstetricians and Gynecologists state that testing for inherited thrombophilias in women who have experienced recurrent fetal loss is not recommended because it is unclear if anticoagulation therapy reduces recurrence. Although there may be an association in these cases, there is insufficient clinical evidence that antepartum prophylaxis with unfractionated heparin or low molecular weight heparin LMWH prevents recurrence in these patients.
Investigators have also found evidence of significantly higher serum homocysteine levels among women with a history of recurrent miscarriage Krabbendam et al, ; Hague, This supplementation should also reduce serum concentrations of homocysteine that may be associated with recurrent pregnancy loss.
The RCOG recommends that in women with recurrent miscarriage who have undergone the above investigations should undergo the following management:. A meta-analysis of randomized controlled trials of immunotherapy for recurrent miscarriage concluded that IVIG and paternal leukocyte injections provided no significant beneficial effect over placebo in preventing further miscarriages Porter et al, The investigators also found no significant benefit for other immunological treatments that have been used for recurrent miscarriage: third party donor cell immunization and trophoblast membrane infusion.
The authors of the meta-analysis concluded that it is questionable whether paternal leukocyte injection is an effective treatment for recurrent miscarriage. They also concluded that third party donor leukocytes, trophoblast membranes, and IVIGs appear to provide no significant beneficial effect over placebo in preventing further miscarriages.
An American Society for Reproductive Medicine Committee Opinion concluded: "IVIG as a treatment for recurrent pregnancy loss should be evaluated in patients who are informed, consenting participants in an institutional review board approved randomized clinical trial. For the management of recurrent spontaneous pregnancy loss IVIG is an experimental treatment.
The University Health Consortium guidelines on use of immunoglobulin preparations concluded that the use of IVIG for recurrent pregnancy loss is "not recommended. Embryo toxicity assay ETA is a laboratory test performed on a woman who has had recurrent early pregnancy loss.
A blood sample from the woman is used to furnish a culture medium for growing mouse embryos. The culture is then examined under microscopy to determine if there are any circulating factors in the blood specimen that are toxic to the developing mouse embryos.
There is a lack of adequate evidence in the peer-reviewed published medical literature on the effectiveness of this test in improving clinical outcomes. The Practice Committee of the American Society for Reproductive Medicine concluded that the use of IVIG for the management of recurrent spontaneous pregnancy loss is an experimental treatment.
Pre-conception infusions were administered 14 to 21 days from the projected next menstrual period. With documentation of pregnancy, the subject received the same infusion every 4 weeks until 18 to 20 weeks of gestation. The primary outcome was an ongoing pregnancy of at least 20 weeks of gestation. A total of 82 patients enrolled, of whom 47 had an index pregnancy. All ongoing pregnancies resulted in live births.
The authors concluded that this is the largest RCT to date in which IVIG was evaluated in women with idiopathic secondary recurrent miscarriage; no treatment benefit was found. In a review on genetics for recurrent pregnancy loss, Sierra and Stephenson stated that recent research has generated interest in genetic markers for recurrent pregnancy loss such as skewed X-chromosome inactivation and human leukocyte antigen-G polymorphisms.
Assisted reproductive technologies specifically, pre-implantation genetic diagnosis have been offered to couples with recurrent pregnancy loss; however, more research is needed before routine use of these new approaches can be advocated. The evaluation begins with an extensive review of medical history and thorough physical examination, followed by a diagnostic screening protocol. The authors noted that management must be evidence-based; unproven treatments should be avoided.
An American Society for Reproductive Medicine Practice Opinion ASRM, concluded that "[a]vailable evidence does not support the use of PGS [preimplantation genetic screening] as currently performed to improve live-birth rates in patients with recurrent pregnancy loss.
Polymorphisms in cytokine genes may affect the risk of RPL, but genetic association studies are often limited by small sample sizes. Meta-analysis of all available studies can increase the precision of these estimates. These researchers evaluated and synthesized the available data from association studies of inflammatory cytokine polymorphisms with RPL. A total of 16 reports of genetic association studies of cytokine polymorphisms with RPL were identified. The authors concluded that available data are inconsistent with more than modest associations between these candidate cytokine polymorphisms and RPL.
They stated that data from future association studies may be added to the meta-analyses to obtain more precise estimates of effect sizes. Treatment groups were stratified by aPL status and history of early versus late pregnancy losses. The primary outcome was live birth; secondary outcomes included adverse events and bone loss at the spine and femoral neck. Literature over the past 20 years was reviewed to identify comparable RCT.
Over 4 years, a total of women with RPL were screened: 88 Anti-phospholipid antibody were present in 42 The trial was stopped after 4 years when an interim analysis showed no difference in live birth rates in the 2 groups, and a lower rate of pregnancy loss in the ASA only group than expected. Neither number of prior losses nor aPL status was correlated with pregnancy outcome.
There were no cases of pregnancy related thrombosis in either group. Kim and colleagues stated that there are several etiological factors associated with immunology, anatomy, endocrinology, genetic, infection, chromosomal abnormalities, and environmental factors contributing to RPL. The aim of this study was to identify RPL associated factors in human blood using proteomics.
Through a comparative analysis between the control and RPL, 21 spots were shown to be differentially expressed. Of these, 5 proteins were confirmed by Western blot analysis. These findings suggested that ITI-H4 expression may be used as a biomarker, which could facilitate the development of novel diagnostic and therapeutic tools. Darmochwal-Kolarz et al estimated the alterations in the phenotype of lymphocytes of women with unexplained pregnancy failures in comparison with healthy women.
A total of 14 women with unexplained habitual miscarriages and 18 healthy, fertile women with the history of successful pregnancies were included in the study. The lymphocytes were isolated from peripheral blood and stained with monoclonal antibodies. The expression of selected surface molecules was estimated using the flow cytometric method. The authors concluded that these findings suggested that the immunological alterations may be involved in the etiopathogenesis of unexplained recurrent pregnancy loss.
The results of this small study need to be validated by well-designed studies. Inflammatory cytokine cascades have been implicated in the pathogenesis of recurrent pregnancy loss. Polymorphisms in cytokine genes may affect the risk of recurrent pregnancy loss, but genetic association studies are often limited by small sample sizes.
In a meta-analysis, Bombell et al assessed and synthesized the available data from association studies of inflammatory cytokine polymorphisms with recurrent pregnancy loss.
Systematic review and random effects meta-analysis of genetic association studies were performed. Data from future association studies may be added to the meta-analyses to obtain more precise estimates of effect sizes. This retrospective case-control study examined well-characterized recurrent pregnancy loss cases for IL-1 gene cluster variants, determined by restriction fragment length polymorphism-PCR. The observed allele, genotype and haplotype distributions were compared with those obtained from ethnically-matched negative controls.
Invariant distribution of IL-1 gene cluster single-nucleotide polymorphisms was observed among recurrent pregnancy loss cases and controls. The authors concluded that no significant difference between recurrent pregnancy loss and control groups was observed at the allele, genotype or haplotype levels when tested for association using the dominant, recessive and additive models of inheritance for IL-1 gene cluster variants.
The authors noted that this is the first report from India pertaining to IL-1 gene cluster variants' association with the risk of recurrent pregnancy loss from North India.
One of the most unfortunate complications of incomplete motherhood is recurrent pregnancy loss particularly of unknown etiology. Both genetic and environmental factors may play a role in the maintenance of pregnancy.
From a traditional immunological perspective, survival of the semi-allogenic fetus is dependent on suppression of the maternal immune response. However, the function of immune cells changes during pregnancy, no generalized suppression of the maternal immune response has been recorded.
This study examined IL-1 gene cluster variants among well-characterized recurrent pregnancy loss patients and compared them with those of healthy controls. Interleukin-1 gene cluster single-nucleotide polymorphisms were found to be invariably distributed among recurrent pregnancy loss patients and controls.
Rao et al determined the frequency of hypothyroidism in women with RPL in first trimester in the Indian population. The study included non-pregnant women with RPL in a gestational age up to less than or equal to 12 weeks verified by a pregnancy test or ultrasonography, and a total of age-matched women with at least 1 successful pregnancy and no history of miscarriages were selected as controls. Levels of thyroid hormones triiodothyronine T3 , thyroxine T4 and thyroid stimulating hormone TSH were estimated in non-pregnant women with RPL and controls.
Hypothyroidism was found in 7 4. The differences in the levels of serum T3, T4 and TSH between euthyroid and hypothyroid women were found significant in women with RPL in first trimester. The authors concluded that the findings of this study demonstrated that hypothyroidism has a statistically significant relationship with RPL in the first trimester and suggested that diagnosis of hypothyroidism could help couples with RPL to have a successful outcome in subsequent pregnancies.
A total of 1, women who had 2 or more consecutive spontaneous pregnancy losses with the same partner were included in this analysis. Main outcome measures included frequencies of abnormal results for evidence-based diagnostic tests considered definite or probable causes of RPL karyotyping for parental chromosomal abnormalities; pelvic sonohysterography, hysterosalpingogram, or hysteroscopy for uterine anomalies; immunological tests for lupus anti-coagulant and anti-cardiolipin antibodies; thrombophilic tests for the factor V Leiden mutation; and blood tests for TSH and fasting blood glucose.
These investigators also measured the frequency of abnormal results for 9 additional investigative tests in the same patients antiphosphatidyl serine antibodies, microbial infection, mid-luteal progesterone, prolactin, functional protein C activity, functional protein S activity, anti-thrombin activity, fasting homocysteine and methylenetetrahydrofolate reductase polymorphisms, and factor II mutation.
The prevalence of abnormal results for evidence-based and investigative diagnostic tests did not differ among women with different numbers of pregnancy losses.
The authors concluded that evaluation of all couples with 2, 3, or more consecutive miscarriages is recommended. In a case-control study, Ticconi et al examined the role of anti-thyroid autoantibodies ATA in recurrent miscarriage RM. Anti-thyroid autoantibodies were detected in 46 Among the women of RM group, The majority of study women were euthyroid. The authors concluded that anti-thyroid autoantibodies, particularly TG-Ab, are associated with RM and could be an expression of a more general maternal immune system abnormality leading to RM.
ICD narrows down obesity codes
Diagnosis Index entries containing back-references to Z Toggle navigation. The following code s above Z In this context, annotation back-references refer to codes that contain: Applicable To annotations, or Code Also annotations, or Code First annotations, or Excludes1 annotations, or Excludes2 annotations, or Includes annotations, or Note annotations, or Use Additional annotations. Factors influencing health status and contact with health services Note Z codes represent reasons for encounters.
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ICD-9-CM (ICD-9, ICD9, ICD9CM) Diagnosis Codes - Group V2
Excludes1: examinations related to pregnancy and reproduction ZZ36, Z A separate procedure code is required to identify any examinations or procedures performed Excludes1: encounter for examination for administrative purposes Z This category is also for use for administrative and legal observation status. Excludes1: contact with and suspected exposures hazardous to health Z Excludes1: encounter for diagnostic examination-code to sign or symptom Z It is not for use on the newborn record. Excludes1: stillbirth P95 Z
Custom Search. Supplementary Classification of Factors Influencing Health Status and Contact with Health Services VV86 This classification is provided to deal with occasions when circumstances other than a disease or injury classifiable to categories the main part of ICD are recorded as "diagnoses" or "problems. This will be a fairly rare occurrence among hospital inpatients, but will be relatively more common among hospital outpatients and patients of family practitioners, health clinics, etc. Such factors may be elicited during population surveys, when the person may or may not be currently sick, or be recorded as an additional factor to be borne in mind when the person is receiving care for some current illness or injury classifiable to categories In the latter circumstances the V code should be used only as a supplementary code and should not be the one selected for use in primary, single cause tabulations.
ICD-10-CM (2010)/CHAPTER 21
Recurrent miscarriage is two or more consecutive pregnancy losses. In many cases the cause of RPL is unknown. After three or more losses, a thorough evaluation is recommended by American Society of Reproductive Medicine. There are various causes for recurrent miscarriage, and some can be treated.
One-click mode. Certain infectious and parasitic diseases AB Neoplasms CD Diseases of the blood and blood-forming organs and certain disorders involving the immune mechanism DD Endocrine, nutritional and metabolic diseases EE Mental and behavioural disorders FF
Note: The following list of codes may apply to genetics clinics. Codes may change and be updated, please verify the applicability for individual patients. ICD-9 coding classification system is used to describe diseases and operations, for physician reimbursement, hospital payments, quality review and benchmarking measurement. The purpose of CPT is to provide a uniform language that accurately describes medical, surgical, and diagnostic services, and serves as an effective means for reliable nationwide communication among physicians, and other healthcare providers, patients, and third parties. Genetic counseling services include obtaining a structured family genetic history, pedigree construction, analysis for genetic risk assessment, counseling of the patient and family. One or more sessions may include a review of medical data and family information, face-to-face interviews, and counseling services.
- К вашему сведению, ваш ТРАНСТЕКСТ перегрелся. - Что ты говоришь? - засмеялся Стратмор. - Что же ты предлагаешь.
Сьюзан Флетчер, - ответил Бринкерхофф. Человек-гигант удивленно поднял брови. Даже перепачканная сажей и промокшая, Сьюзан Флетчер производила более сильное впечатление, чем он мог предположить. - А коммандер? - спросил .
Сьюзан быстро встала и, расплескивая воду, потянулась к трубке, лежавшей на краю раковины. - Дэвид. - Это Стратмор, - прозвучал знакомый голос.
За годы работы в АНБ до нее доходили слухи о неофициальных связях агентства с самыми искусными киллерами в мире - наемниками, выполняющими за разведывательные службы всю грязную работу.
Этот разговор был ей неприятен. - Ну, мы не сумели этого сделать. - А вдруг Танкадо умнее. - Может. - Сьюзан пожала плечами, демонстрируя равнодушие.
Он сказал, что ты будешь очень расстроена, если поездку придется отложить. Сьюзан растерялась. - Вы говорили с Дэвидом сегодня утром. - Разумеется. - Стратмора, похоже, удивило ее недоумение.
- Мне пришлось его проинструктировать. - Проинструктировать.
Давайте скорее, - сказала Сьюзан, пытаясь что-нибудь разглядеть сквозь тяжелую стеклянную дверь. Она знала, что, пока ТРАНСТЕКСТ будет продолжать сжирать аварийное питание, она останется запертой в Третьем узле. Стратмор отпустил створки двери, и тонюсенькая полоска света исчезла.