dysfunctional uterine bleeding & uterine fibroids - Health Plan of ...

More documents

Recommendations

Info

WOU001 http://www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfPMA/pma.cfm?id=13208. Accessed June 30, 2010. The NovaSure® Impedance Controlled Endometrial Ablation System (Hologic, Inc.) received premarket approval (PMA) on September 28, 2001 for ablation of the endometrial lining of the uterus in premenopausal women with menorrhagia due to benign conditions for whom childbearing is complete. See the following website for more information: http://www.accessdata.fda.gov/scripts/cdrh/cfdocs/cftopic/pma/pma.cfm?num=p010013. Accessed June 30, 2010. The Microsulis® Microwave Endometrial Ablation (MEA) System received premarket approval (PMA) on September 23, 2003 for ablation of the endometrial lining of the uterus in premenopausal women with menorrhagia due to benign conditions for whom childbearing is complete. See the following website for more information: http://www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfTopic/pma/pma.cfm?num=P020031. Accessed July 1, 2010. The Cryo-Hit System (Galil Medical) first received 510(k) approval from the FDA on July 1, 1998. Modified versions of the device received 510(k) approval on July 12, 1999 and October 30, 2001. The device is intended for the cryosurgical destruction of tissue during gynecological procedures as well as in general, dermatological, neurosurgical, thoracic, oncological, rectal, and urological surgeries. See the following website for more information: http://www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfPMN/pmn.cfm. Accessed June 30, 2010. Magnetic Resonance Imaging-Guided Focused Ultrasound The ExAblate 2000 System received premarket approval (PMA) on October 22, 2004 for ablation of uterine fibroid tissue in pre- or perimenopausal women with symptomatic uterine fibroids who desire a uterine sparing procedure. See the following website for more information: http://www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfPMA/pma.cfm?id=3720. Accessed June 30, 2010. Levonorgestrel-Releasing Intrauterine Device MIRENA© received FDA approval on December 8, 2000 for use as an intrauterine contraceptive. Treatment of heavy menstrual bleeding for women who choose to use intrauterine contraception as their method of contraception was approved as an additional indication on October 1, 2009. See the following Web site for more information: http://www.accessdata.fda.gov/scripts/cder/drugsatfda/index.cfm?fuseaction=Search.DrugDetails. Accessed June 25, 2010. Uterine Artery Embolization Uterine artery embolization (UAE) is a procedure and, therefore, not subject to FDA regulation. However, the embolic agents used are subject to FDA oversight. A number of agents are approved by the FDA for embolization procedures of the neurological system, but several have been specifically approved for UAE. See the following website for additional information (use product code HCG): http://www.accessdata.fda.gov/scripts/cder/drugsatfda/index.cfm?fuseaction=Search.DrugDetails. Accessed June 25, 2010. Dysfunctional Uterine Bleeding & Uterine Fibroids Page 16 of 24
WOU001 APPLICABLE CODES The codes listed in this policy are for reference purposes only. Listing of a service or device code in this policy does not imply that the service described by this code is a covered or non-covered health service. Coverage is determined by the benefit document. This list of codes may not be all inclusive. CPT ® Code Description Focused ultrasound ablation of uterine leiomyomata, including MR guidance; total 0071T leiomyomata volume less than 200 cc of tissue Focused ultrasound ablation of uterine leiomyomata, including MR guidance; total 0072T leiomyomata volume greater or equal to 200 cc of tissue Uterine fibroid embolization (UFE, embolization of the uterine arteries to treat uterine fibroids, leiomyomata), percutaneous approach inclusive of vascular access, 37210 vessel selection, embolization, and all radiological supervision and interpretation, intraprocedural roadmapping, and imaging guidance necessary to complete the procedure 58353 Endometrial ablation, thermal, without hysteroscopic guidance Endometrial cryoablation with ultrasonic guidance, including endometrial 58356 curettage, when performed Hysteroscopy, surgical; with endometrial ablation (eg, endometrial resection, 58563 electrosurgical ablation, thermoablation) CPT ® is a registered trademark of the American Medical Association. HCPCS Code J7302 J7306 S4981 Description Levonorgestrel-releasing intrauterine contraceptive system, 52 mg Levonorgestrel (contraceptive) implant system, including implants and supplies Insertion of levonorgestrel-releasing intrauterine system ICD-9 Codes Description 617.0 Endometriosis of uterus 617.9 Endometriosis, site unspecified 626.0 Absence of menstruation 626.1 Scanty or infrequent menstruation 626.2 Excessive or frequent menstruation 626.3 Puberty bleeding 626.4 Irregular menstrual cycle 626.5 Ovulation bleeding 626.6 Metrorrhagia 626.7 Postcoital bleeding 626.8 Other disorder of menstruation and other abnormal bleeding from female genital tract 626.9 Unspecified disorder of menstruation and other abnormal bleeding from female genital tract 627.0 Premenopausal menorrhagia Dysfunctional Uterine Bleeding & Uterine Fibroids Page 17 of 24
Page 1 and 2: WOU001 DYSFUNCTIONAL UTERINE BLEEDI
Page 3 and 4: Articles exist for uterine artery e
Page 5 and 6: postembolization pain, but the abun
Page 7 and 8: Rosenbaum et al. (2005) evaluated H
Page 9 and 10: follow-up, 116 of the 129 women in
Page 11 and 12: WOU001 Levonorgestrel-Releasing Int
Page 13 and 14: Siskin et al. (2006) compared UAE t
Page 15: In an updated practice bulletin, AC
Page 19 and 20: WOU001 Barrington JW, Bowen-Simpkin
Page 21 and 22: Grainger DA, Tjaden BL, Rowland C,
Page 23 and 24: WOU001 Pron G, Cohen M, Soucie J, e

dysfunctional uterine bleeding & uterine fibroids - Health Plan of ...

You also want an ePaper? Increase the reach of your titles

Delete template?

Save as template?