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Case Definition: Uterine Leimyomas (Fibroids), Lecture notes of Clinical Medicine

of uterine leiomyomas (see ICD9 and ICD10 code lists below) in the primary ... Symptomatic fibroids can cause appreciable morbidity and.

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1 GYN 9
AFHSC Surveillance Case Definitions
FINAL January 2015
Case Definition and Incidence Rules
For surveillance purposes, a case of uterine leiomyomas or “fibroids” is defined as:
One hospitalization or outpatient medical encounter with any of the defining diagnoses
of uterine leiomyomas (see ICD9 and ICD10 code lists below) in the primary
diagnostic position; or
One hospitalization or outpatient medical encounter with any of the defining diagnoses
of uterine leiomyomas (see ICD9 and ICD10 code lists below) in the secondary
diagnostic position; AND at least one associated symptom (see ICD9 and ICD10 code
lists below) in the primary diagnostic position.
Incidence rules:
For individuals who meet the case definition:
The incidence date is considered the date of the first hospitalization or outpatient
medical encounter that includes a defining diagnosis of uterine leiomyomas.
An individual is considered an incident case only once per lifetime.
(continued on next page)
UTERINE LEIOMYOMAS (FIBROIDS)
Background
This case definition was developed by the Armed Forces Health Surveillance Center (AFHSC) for the
purpose of epidemiological surveillance of a condition important to military-associated populations. In
the U.S. Armed Forces in 2010, “uterine leiomyoma” (ICD9 code: 218) was the 5 th most frequent
diagnosis during hospitalizations for active component females, and the 2nd most frequent diagnosis
during ambulatory visits for neoplasms.
1
,
2
Clinical Description
Uterine leiomyomas, or “fibroids”, are benign, often asymptomatic tumors of the uterus that occur
frequently in premenopausal women. Symptomatic fibroids can cause appreciable morbidity and
disability in affected women; common symptoms include heavy, painful menstrual bleeding, pelvic
pain, urinary frequency, and reproductive difficulties. Treatments for symptomatic fibroids vary
according to the size, location, and number of fibroids, the severity of symptoms, and the patient’s
desire to retain reproductive ability. Therapeutic options range from watchful waiting and drug therapy
to surgical procedures such as hysterectomy (removal of the uterus) and myomectomy (removal of the
fibroid).
3
1
Armed Forces Health Surveillance Center. Hospitalizations among members of the active component,
U.S. Armed Forces, 2010. Medical Surveillance Monthly Report (MSMR). 2011; 18(4): 8-15.
2
Armed Forces Health Surveillance Center. Ambulatory visits among members of the active component,
U.S. Armed Forces, 2010. Medical Surveillance Monthly Report (MSMR). 2011; 18(4): 16-21.
3
Armed Forces Health Surveillance Center. Uterine fibroids, active component females, U.S. Armed
Forces, 2001-2010. Medical Surveillance Monthly Report (MSMR). 2011; 18(12): 10-13.
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AFHSC Surveillance Case Definitions

Case Definition and Incidence Rules

For surveillance purposes, a case of uterine leiomyomas or “fibroids” is defined as:

One hospitalization or outpatient medical encounter with any of the defining diagnoses of uterine leiomyomas (see ICD9 and ICD10 code lists below) in the primary diagnostic position; or

One hospitalization or outpatient medical encounter with any of the defining diagnoses of uterine leiomyomas (see ICD9 and ICD10 code lists below) in the secondary diagnostic position; AND at least one associated symptom (see ICD9 and ICD10 code lists below) in the primary diagnostic position.

Incidence rules:

For individuals who meet the case definition:

 The incidence date is considered the date of the first hospitalization or outpatient medical encounter that includes a defining diagnosis of uterine leiomyomas.

 An individual is considered an incident case only once per lifetime.

(continued on next page)

UTERINE LEIOMYOMAS (FIBROIDS)

Background

This case definition was developed by the Armed Forces Health Surveillance Center (AFHSC) for the purpose of epidemiological surveillance of a condition important to military-associated populations. In the U.S. Armed Forces in 2010, “uterine leiomyoma” (ICD9 code: 218) was the 5th^ most frequent diagnosis during hospitalizations for active component females, and the 2nd^ most frequent diagnosis during ambulatory visits for neoplasms.^1 ,^2

Clinical Description

Uterine leiomyomas, or “fibroids”, are benign, often asymptomatic tumors of the uterus that occur frequently in premenopausal women. Symptomatic fibroids can cause appreciable morbidity and disability in affected women; common symptoms include heavy, painful menstrual bleeding, pelvic pain, urinary frequency, and reproductive difficulties. Treatments for symptomatic fibroids vary according to the size, location, and number of fibroids, the severity of symptoms, and the patient’s desire to retain reproductive ability. Therapeutic options range from watchful waiting and drug therapy to surgical procedures such as hysterectomy (removal of the uterus) and myomectomy (removal of the fibroid).^3

(^1) Armed Forces Health Surveillance Center. Hospitalizations among members of the active component,

U.S. Armed Forces, 2010. Medical Surveillance Monthly Report (MSMR). 2011; 18(4): 8-15. (^2) Armed Forces Health Surveillance Center. Ambulatory visits among members of the active component,

U.S. Armed Forces, 2010. Medical Surveillance Monthly Report (MSMR). 2011; 18(4): 16-21. (^3) Armed Forces Health Surveillance Center. Uterine fibroids, active component females, U.S. Armed

Forces, 2001-2010. Medical Surveillance Monthly Report (MSMR). 2011; 18(12): 10-13.

AFHSC Surveillance Case Definitions

Case Definition and Incidence Rules (continued)

Exclusions:

 Individuals with a case defining encounter of uterine fibroids prior to the surveillance period.

Codes

The following ICD9 codes are included in the case definition:

Condition ICD-10-CM Codes ICD-9-CM Codes

Uterine leiomyomas (Fibroids)

D25 (leiomyoma of uterus) 218 (uterine leiomyoma)

D25.0 (submucous leiomyoma of uterus) 218.0 (submucous leiomyoma of uterus)

D25.1 (intramural leiomyoma of uterus) 218.1 (intramural leiomyoma of uterus)

D25.2 (subserosal leiomyoma of uterus) 218.2 (subserous leiomyoma of uterus)

D25.9 (leiomyoma of uterus, unspecified) 218.9 (leiomyoma of uterus, unspecified)

Associated Symptoms ICD-10-CM Codes ICD-9-CM Codes

Anemia due to blood loss

D50.0 (iron deficiency anemia secondary to blood loss; chronic)

280.0 (iron deficiency anemia secondary to chronic blood loss)

D62 (acute posthemorrhagic anemia) 285.1 (acute post hemorrhagic anemia)

Vaginal bleeding, menstrual bleeding disorders

N89.8 (other specified noninflammatory disorders of vaginia)

623.8 (other specified non-inflammatory disorders of vagina)

N92.0 (excessive and frequent menstruation with regular cycle)

626.2 (excessive or frequent menstruation)

N92.1 (excessive and frequent mensturation with irregular cycle)

626.6 (metrorrhagia)

N92.3 (ovulation bleeding) 626.5 (ovulation bleeding)

N92.4 (excessive bleeding in the premenopausal period)

627.0 (premenopausal menorrhagia)

N92.5 (other specified irregular menstruation)

626.8 (other; dysfunctional or functional uterine hemorrhage not otherwise specified)

N92.6 (irregular menstruation, unspecified)

626.9 (disorders of menstruation and other abnormal bleeding from female genital tract, unspecified) (continued on next page)

AFHSC Surveillance Case Definitions

Reports

None

Review

Jan 2015 Case definition reviewed and updated by the AFHSC Surveillance Methods and Standards (SMS) working group.

Jan 2012 Case definition reviewed and adopted by the AFHSC Surveillance Methods and Standards (SMS) working group.

Dec 2011 Case definition developed by AFHSC MSMR staff.

Comments

In the MSMR article referenced above procedure codes are listed in the ICD9 code list (Table 1) 3. These codes are not case-defining codes or related symptom codes, but rather codes used to measure health care burden. Therefore, they are not included in the code list for this case definition.