Resource Roundup
March is Endometriosis Awareness Month! We've combed our resources and compiled a list of our Practice Documents, Patient Fact Sheets, and more on endometriosis.
Endometriosis
Date: March 07, 2024
Author: ASRM
Practice Documents for Endometriosis
Below, we have linked two practice documents currently available and a takeaway teaser from each.ENDOMETRIOSIS AND INFERTILITY: A COMMITTEE OPINION (2012)
“Endometriosis is a common, chronic disease. Although women may be asymptomatic, most women typically present with pelvic pain, infertility, or an adnexal mass. Treatment of endometriosis in the setting of infertility raises a number of complex clinical questions. The purpose of this document is to review the current literature regarding the implications of endometriosis and its management on reproduction.”BEST PRACTICES OF ASRM AND ESHRE: A JOURNEY THROUGH REPRODUCTIVE MEDICINE (2012)
“The main principles of treatment for Endometriosis-Associated Chronic Pelvic Pain are that: (i) initial surgery is more effective than medical treatment, but multiple surgeries should be avoided; (ii) all hormone-altering medications have equivalent efficacy but have different side effects; (iii) 3 months of initial treatment is as effective as 6 months; (iv) 3 months re-treatment is as effective as 6 months of initial treatment; (v) shorter courses of medication have fewer side effects including bone loss; (vi) the ideal add-back regimen after GnRH agonist therapy has not been established; (vii) oral contraceptives are effective for maintenance in patients; (viii) different medical therapies can be used sequentially in the same patient; (ix) since hysterectomy and oophorectomy frequently may become necessary, attention to fertility issues is mandatory and (x) biopsychosocial issues are a critical component of effective care.”ROLE OF TUBAL SURGERY IN THE AREA OF ASSISTED REPRODUCTIVE TECHNOLOGY: A COMMITTEE OPINION
"This document reviews surgical options for reparative tubal surgery and the factors that must be considered when deciding between surgical repair and in vitro fertilization."Patient Fact Sheets for Endometriosis
View key takeaways below, then click the link to view the full Fact Sheet.CONDITIONS TREATED WITH ADNEXAL SURGERY
"Surgery can be used to treat problems with ... your ovaries or fallopian tubes such as cysts, endometriosis, or infections."ENDOMETRIAL ABLATION
"Endometrial ablation is a medical procedure that removes the lining of the uterus."ENDOMETRIOSIS (BOOKLET)
"Women with endometriosis may experience infertility, pelvic pain, or both. This booklet will describe options for diagnosing and treating pain or infertility that may be attributed to endometriosis."ENDOMETRIOSIS: DOES IT CAUSE INFERTILITY?
"When tissue like the tissue that normally lines the inside of the uterus (endometrium) is found outside the uterus, it is termed “endometriosis.”"ENDOMETRIOSIS AND INFERTILITY: CAN SURGERY HELP?
"Endometriosis is when tissue is found outside the uterus that appears similar to the lining of the uterus (endometrium). Endometriosis may grow on the outside of your uterus, ovaries, tubes and even on your bladder or intestines. This tissue can irritate structures that it touches, causing pain and adhesions (scar tissue) on these organs."HYDROSALPINX
"Damage and blockage of the end portion of a fallopian tube can cause it to become filled with fluid; the swollen and fluid-filled tube is called a hydrosalpinx."HYSTEROSALPINGOGRAM (HSG)
"A hysterosalpingogram or HSG is an x-ray procedure used to see whether the fallopian tubes are patent (open) and if the inside of the uterus (uterine cavity) is normal. HSG is an outpatient procedure that usually takes less than 5 minutes to perform. It is usually done after the menstrual period ends but before ovulation."INTRAUTERINE ADHESIONS: WHAT ARE THEY?
"Injury to and/or infection of the endometrium may damage the lining and cause formation of adhesions (scar tissue) between the inner walls of the uterus where the walls abnormally adhere or stick to each other. Asherman syndrome is a term used to describe adhesions inside the uterus."LAPAROSCOPY AND HYSTEROSCOPY
"An examination of a woman’s internal pelvic structure can provide important information regarding infertility and common gynecologic disorders. Problems that cannot be discovered by an external physical examination may be discovered by laparoscopy and hysteroscopy, two procedures that provide a direct look at the pelvic organs. These procedures may be recommended as part of your infertility care, depending on your particular situation. Laparoscopy and hysteroscopy can be used for both diagnostic (looking only) and operative (looking and treating) purposes."MANAGING PELVIC PAIN
"Many women have pain in their pelvis (lower part of the belly) from time to time, usually during their period. However, if you have daily pelvic pain, it could be a sign of a bigger problem with your bladder, bowels, reproductive organs, or pelvic muscles. Many conditions cause pelvic pain, including endometriosis, adhesions, chronic appendicitis, or hernias."
NONCONTRACEPTIVE BENEFITS OF BIRTH CONTROL PILLS
"Another cause of painful menstrual cycles is endometriosis. When the tissue lining the uterus (endometrium) grows outside of the uterus it is called endometriosis. Just as progesterone limits the growth of the uterine lining, the progesterone-like hormones in birth control pills can limit or decrease the growth of endometriosis. Because of this, birth control pills can reduce the pain associated with endometriosis for many women."WHAT DO I NEED TO KNOW ABOUT CONCEIVING AFTER TUBAL SURGERY?
"Endometriosis is a common gynecologic condition that can be associated with damage to your tubes. Women who have pelvic pain, pain during sex or painful periods, and are also having trouble getting pregnant may be at risk of endometriosis."You can access all our fact sheets through both www.asrm.org and ASRM’s patient website, www.ReproductiveFacts.org. To view all Patient Fact Sheets, head to the “Practice Guidance” menu and hover over “News and Publications.” From the drop-down menu, select “Fact Sheets and Infographics.” You can scroll to browse resources.
Coding Resources for Endometriosis
Endometriosis is a particularly difficult field for coding owing to extensive variability in symptoms, severity, and location. Severe disease can result in subspecialty support from gynecologic oncology, urology, general or colorectal surgery, and even cardiothoracic surgery in the case of diaphragmatic endometriosis. Though there are exceptional reproductive surgeons capable of procedures normally reserved for other fields, this summary will focus on conditions and procedures that can be performed by the majority of REI’s and OB/GYN’s.VIEW A SUMMARY OF CODES FOR ENDOMETRIOSIS
FEB 2023: NEW ENDOMETRIOSIS AND ISTHMOCELE CODES
Recorded Webinars for Endometriosis
Interested in longer-form learning? Turn in to one of our recorded webinars on endometriosis to deepen your understanding of the topic.ASRM Webinars
Preoperative Ultrasonographic Assessment of Urinary Tract and Bowel Endometriosis
This webinar will describe the assessment of bowel and urinary tract endometriosis by using bidimensional and 3D ultrasound. Moderated by Sawsan As-Sanie, MD, MPH, and featuring Simone Ferrero, MD, PhD, and Stefano Guerriero, MD.Racial Disparities in Endometriosis Treatment: How do we close the gap?
The goal of this webinar is to assess and discuss racial differences in endometriosis diagnosis and treatment. Moderated by Rebecca Flyckt, MD, and featuring Kim L. Thornton, MD, Gloria Richard-Davis, MD, and Zaraq Khan, MBBS.Fertility and Sterility Journal Club Global
JOURNAL CLUB GLOBAL - DOES THE ENDOMETRIUM PLAY A MAJOR ROLE IN ENDOMETRIOSIS-ASSOCIATED INFERTILITY
This event in the style of the "Fertile Battle" debate that took place at the 2019 SREI Fellows Symposium is moderated by Drs. Barnhart and Hill. Faculty Discussants include Eric Widra, MD; Erica Johnstone, MD, MHS; Gaurang Daftary, MD; Emily Jungheim, MD; and Richard J. Paulson, MD. Fellow Discussants include Michael Awadalla, MD, USC; Juilia Kim, MD, MPH, RMA-NJ; Anne Martini, DO, NIH; and Vinita Alexander, MD, WashU Saint Louis.JOURNAL CLUB GLOBAL: NON-INVASIVE DIAGNOSIS OF ENDOMETRIOSIS
One of the most exciting developments in the field of endometriosis is the push towards earlier and less invasive approaches to diagnosis. This webinar, in collaboration with the British Society for Gynecologic Endoscopy, explores work being done in biomarkers and advanced pelvic ultrasound as a means to shorten the delay in diagnosis for women suffering with pelvic pain.JOURNAL CLUB GLOBAL: ACTUALIDAD EN TRATAMIENTOS DE FERTILIDAD PARA PACIENTES CON ENDOMETRIOSIS
En vivo en español de la reunión de la Sociedad Peruana de Fertilidad del 2024 Lima, Perú. Los dos artículos que se discutirán: "Endometriosis is associated with pregnancy loss: a nationwide historical cohort study” y “Severe maternal morbidity associated with endometriosis: a population-based, retrospective cohort study.JOURNAL CLUB GLOBAL: SURGICAL MANAGEMENT OF ENDOMETRIOSIS IN WOMEN DIAGNOSED WITH INFERTILITY (SPANISH LANGUAGE)
The meeting includes a group of experts on surgical management of endometriosis, who will discuss two Fertility and Sterility video articles demonstrating techniques to identify and remove deep infiltrating endometriosis and endometriosis located in challenging locations, such as the diaphragm, bladder, or bowel.Podcast Episodes on Endometriosis
Tune in to podcast episodes dedicated to endometriosis on ASRM Today, SART Fertility Experts, and Fertility and Sterility on Air. Download episodes wherever you access your podcasts or use the links below to listen.ASRM Today
ASRM Today: Below the Belt Documentary with Director Shannon Cohn
In this episode, director Shannon Cohn discusses her new documentary, Below the Belt. We'll explore the inspiration behind the film and its impact on the audience. Join us as we uncover the emotional and thought-provoking aspects of this remarkable documentary on endometriosis.SART Fertility Experts
SART Fertility Experts: Endometriosis
Endometriosis is a condition that can affect many facets of a person’s life, from pelvic pain to struggles with infertility. Listen as Christine discusses her experiences during her journey to motherhood with Dr. Joseph Findley, a reproductive endocrinologist and member of the Society for Reproductive Surgeons.
Fertility and Sterility On Air
ON AIR–LIVE FROM ESHRE: PART 2
Tune in at 24:10 to learn more about a bioengineering approach to the study of endometriosis and adenomyosis.ASRM also has a Special Interest Group focusing on endometriosis. Click here to learn more about EndoSIG.
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Topic Resources
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Live in Spanish from the 2024 Peruvian Fertility Society Meeting - Lima, Peru View the Video
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My wife and I have been seeking IVF treatment and this year coverage was added to my benefits for infertility treatment (up to $25,000). View the Answer
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Surgery was performed under anesthesia for Aspiration of right hydrosalpinx fluid and right endometrioma. Which CPT code would be best to use? View the Answer
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My wife and I have been seeking IVF treatment and coverage was added for infertility treatment (up to $25,000) but our insurer keeps denying it. View the Answer
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Medication Administration
Is CPT code 96402 applicable to a Depo-Lupron or Zoladex injection by nurse at REI practice, even if there is no diagnosis of cancer? View the Answer
Endometriosis and Infertility
For treatment like IVF would we bill with N97.x first or an endometriosis diagnosis? View the Answer
Excision Ovarian Endometrioma
What code is used for a laparoscopic excision of endometriosis and an ovarian excision of endometrioma with bilateral ureterolysis is performed. View the Answer
Endometriosis
A summary of common codes for Endometriosis compiled by the ASRM Coding Committee View the Coding Summary
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Feb 2023: New Endometriosis and Isthmocele Codes
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Best practices of ASRM and ESHRE: a journey through reproductive medicine (2012)
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