How to Diagnose, Determine Treatment, and Code Endometrial Cancer

How to Diagnose, Determine Treatment, and Code Endometrial Cancer

Endometrial cancer occurs when the cells in the inner lining of the uterus begin to multiply abnormally.

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Endometrial cancer is the most common cancer of the female reproductive system and the fourth most common cancer among women in general, (after breast cancer, lung cancer, and colorectal cancer). Also known as uterine cancer, it is a malignant tumor that begins in the layers of cells that form the lining (endometrium) of the uterus (a hollow pear-shaped pelvic organ in women where fetal development occurs). This malignant tumor has the capacity to attack or grow into and destroy nearby tissue. In addition, it can also spread or metastasize, to other parts of the body. The most common symptoms of endometrial cancer are abnormal vaginal bleeding, ranging from a watery and blood-streaked flow to a flow that contains more blood. In addition, pelvic pain, bleeding between periods, trouble urinating and pain during intercourse are some of the other associated symptoms.

Generally, endometrial cancer is detected at an early stage due to the frequent episodes of abnormal vaginal bleeding, which prompt women to consult their gynecologists. If detected at an early stage, removing the uterus surgically often cures endometrial cancer. Obstetrics and gynecology medical billing and coding is very complex, as it involves several rules related to reporting the procedures accurately. Medical coding companies and coding staff at hospitals and healthcare clinics need to stay up-to-date with the latest codes and guidelines to document uterine cancer accurately.

According to reports from the American Cancer Society (ACR, 2018 statistics), about 63,230 new cases of cancer of the body of the uterus (uterine body or corpus) will be diagnosed. It is estimated that 11,350 women will die from cancers of the uterine body. The condition mostly affects postmenopausal women, with the average age being 60 years.

There are

two types of cancer of the uterus. The former is - uterine sarcomas, (which start in the muscle layer (myometrium) or supporting connective tissue of the uterus). The second type is - endometrial carcinomas, (which start in the cells of the inner lining of the uterus /endometrium) What Are the Causes and Risk Factors?

The exact cause of endometrial cancer is not known. However, a genetic mutation that occurs within the cells in the endometrium - the lining of the uterus, is believed to cause the condition. The genetic mutation turns normal, healthy cells into abnormal cells. Healthy cells grow and multiply at a set rate and eventually die at a set time. On the other hand, abnormal cells grow and multiply out of control, and don’t die at a set time. The accumulating abnormal cells happen to form a mass (tumor). These cancer cells invade nearby tissues and can separate from an initial tumor to spread elsewhere in the body (metastasize).

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There are several factors that increase the risk of this type of cancer. The most important factor is related to the production of the hormone estrogen. Estrogen stimulates the lining of the uterus (the endometrium) to grow. Women with high levels of estrogen in their body are at increased risk of endometrial cancer. Most types of cancers of the endometrium appear after menopause, and the risk continues to increase with each successive decade.

About 95% of these cancers occur in women above the age of 40 years. Some of the other associated risk factors include - obesity, older age, hormone therapy for breast cancer, an inherited colon cancer syndrome, more years of menstruation and women who have never being pregnant.

Making the Correct Diagnosis and Treatment There is no specific screening test for endometrial cancer. However, a combination of tests and procedures is used to accurately diagnose endometrial cancer and these include 

Pelvic exam

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Transvaginal ultrasound (using sound waves to create a picture of your uterus, to examine the thickness and texture of the endometrium)

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Hysteroscopy

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Removing a sample of tissue for testing

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Dilation and curettage (D&C - to remove tissue for testing)

At the end of these tests, if endometrial cancer is confirmed, patients are more likely to be referred to a gynecologic oncologist who specializes in treating cancers involving the female reproductive system. These specialists may further work towards determining the severity and extent/stage of cancer. Several tests like chest X-ray, a computerized tomography (CT) scan, positron emission tomography (PET) scan and blood tests may be done to determine the stage of your cancer.

Treatment options for endometrium cancer are numerous, which will mainly depend on the characteristics of your cancer, such as the type, stage, your general health and your individual preferences. Surgery to remove the uterus is recommended for most women with this type of cancer. Women, generally undergo hysterectomy to remove the uterus and hysterectomy with salpingo-oophorectomy to remove the fallopian tubes and ovaries as well. In addition, your surgeon will also inspect the area around your uterus to check for any possible signs that the cancer has spread. Other treatment modalities include radiation therapy, chemotherapy and hormone therapy (involves taking medications to reduce the amount of estrogen and increase the amount of progesterone in your body).

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For appropriate reimbursement, healthcare providers should ensure that the diagnostic codes on billing claims for endometrial cancer accurately reflect their specific diagnosis.

Gynecologic oncologists who treat this condition rely on reputable medical billing companies to code the condition accurately.

Relevant ICD-10 Codes for Uterine Cancer C54 - Malignant neoplasm of corpus uteri 

C54.0 - Malignant neoplasm of isthmus uteri

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C54.1 - Malignant neoplasm of endometrium

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C54.2 - Malignant neoplasm of myometrium

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C54.3 - Malignant neoplasm of fundus uteri

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C54.8 - Malignant neoplasm of overlapping sites of corpus uteri

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C54.9 - Malignant neoplasm of corpus uteri, unspecified

C55 - Malignant neoplasm of uterus, part unspecified Most cases of uterine cancers can be prevented with early identification of symptoms and causes. As obesity is a strong risk factor for this condition, exercising regularly to maintain a healthy body weight in vital. Overweight women are 3 to 10 times more likely than average to develop endometrial cancer, (depending on how much extra weight they carry and how long they have carried it). This is because fatty tissue in women produces large amounts of estrogen which stimulate the growth of the uterus lining (the endometrium). Regular physical activity combined with healthy and low-fat diet can provide added benefits in such situations. For those who are considering hormone replacement therapy to help control menopause symptoms, discuss the pros and cons of the same with your physician and how it will affect your risk of endometrial cancer. In addition, getting proper treatment for precancerous disorders of the endometrium is another way to lower the risk of endometrial cancer.

Partnering with an established medical billing and coding outsourcing company can ensure correct reporting of gynecology procedures. Such companies have experienced AAPC-certified coders who are knowledgeable in the coding and billing guidelines for this specialty and can ensure accurate medical claims.

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