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I HAVE A PT WHO HAS H/O DVT IN THE PAST AND WANTS TO BE ON BIRTH CONTROL FOR HEAVY BLEEDING.ANY SUGGESTIONS???
I WILL REFER HER TO GYN BUT I AM CURIOUS WHAT U GUYS WILL DO??

DO U KNOW WHERE TO LOOK 4 MODIFIERS.MY BILLING COMPANY WANTS TO KNOW MODIFIER FOR ALBUTEROL WHERE TO LOOK 4 IT IN A EASY WAY.

LAJU

STOP YELLING!

Unless you are sending this by texting on a telephone, try typing in complete words and sentences in upper and lower case.

Now to the questions. I would not put her on hormonal therapy after DVT. If she has not had a thrombophilia workup, that is needed.
If the thrombophilia workup is negative I would leave it it the GYN to take the risk of hormonal therapy.
If positive I would be very leery about hormonal therapy.

As regards albuterol, are you asking for the CPT code or a modifier to the code?
What is the modifier for?

Greg Phillips
ps if you are texting this from your phone or Blackberry, WHY?

I am looking for modifier to the CPT code.
Thanx for replying the question.

Albuterol doesn't need a modifier. It needs J-code. You can find J-codes for albuterol in the Table of Drugs
2008 Table of Drugs

Hello Laju
I enjoy coding mysteries and would like to help.
What do you mean by a modifier for albuterol?

PS don't do it-the birth control

PSS TYPE IN ALL CAPS ANYTIME YOU WANT

PSSs TEXT FROM YOUR PHONE OR YOUR BLACKBERRY OR FROM WHEREEVER YOU WANT

Laju,

I would not prescribe BCPs. I would tell her that BCPS are not indicated in women who have had a DVT. I would tell her that you are referring her to a GYN and that, should the GYN feel it is appropriate, they can prescribe them to her. Let the GYN take the risk.

Leslie

I agree that estrogens should be avoided in a patient with h/o thrombosis. Even low dose estrogens have been shown to significantly increase the risk of thrombosis. Anyhow, you have several relatively safe alternatives:

-- The newly released Mirena IUD releases progestins, but only low levels of progestins get into the blood stream. It may, therefore, be a particularly suitable for use in individuals with thrombosis or thrombophilia. Even though I am not aware of any systematic investigation regarding its risk of causing thrombosis, I would not expect Mirena to increase that risk. It can also be used for contraception.
-- Depo-Provera has been noted to have "No increased risk of deep vein thrombosis (DVT), pulmonary embolism (PE), stroke, or myocardial infarction." (see http://www.quickoverview.com/reproductive/depo-provera.html) In their product circular, though, they will state that it be "Used with Caution in... patients with a history of blood clots in the blood vessels (thromboembolism)." (see http://www.netdoctor.co.uk/medicines/100000717.html) Approximately, 80% to 90% of patients completing 12 months of Depo-Provera therapy will be amenorrheic.
-- Cyclical progesterone therapy stabilizes the proliferative endometrium and induces regular sloughing. Cyclical progesterone therapy is useful in women with contraindications to estrogen therapy (ie, women older than 35 years of age who smoke, history of deep venous vein thrombosis, or high risk factors for cardiovascular disease). Generally, medroxyprogesterone acetate 10 mg for 10 to 14 days each month will induce a regular withdrawal bleed. This dosage will not provide contraception.

I agree wholeheartedly in getting a GYN involved to rule out gynecological causes of heavy uterine bleeding. I would also get a hematologist (like myself) to share the risk of recurrent DVT. He can in the meantime do a full coagulopathy workup (see http://www.emedicine.com/med/TOPIC2785.HTM for an excellent review). All 3 of you need to determine what is this woman's worse risk- having complications from her heavy bleeding or from her h/o DVT.

Good luck!

Al