Counseling

When counseling patients about the use of contraception, nonjudgmental, impartial communication is best. Patients often bring experience, opinions, and some knowledge

Table 26-1 ICD-9 Codes Used for Contraception Reimbursement

Code

Description

V25.0

General counseling and advice on contraceptive management

V25.01

Oral contraceptive initiation or counseling

V25.02

Initiation of other contraceptive method (diaphragm fitting, foam, etc)

V25.03

Encounter for emergency contraceptive counseling and prescription

V25.04

Counseling and instruction on natural family planning to avoid pregnancy

V25.09

Other family planning advice

V25.1

IUD, insertion

V25.2

Sterilization

V25.3

Menstrual extraction/regulation

V25.4

Surveillance of previously prescribed contraceptive methods

V25.40

Contraceptive surveillance, unspecified

V25.41

Repeat prescription/surveillance of OCPs

V25.42

IUD check, re-insertion or removal

V25.43

Surveillance of implantable subdermal contraceptive

V25.49

Surveillance of other prescribed contraceptive method

V25.5

Insertion of implantable subdermal contraceptive

V25.8

Post-vasectomy sperm count

V25.9

Unspecified contraceptive management

V26.4

General and counseling and advice on procreative management

V26.41

Procreative counseling and advice using natural family planning

V26.42

Other procreative management and advice

V26.5

Sterilization status

V26.51

Tubal ligation status

V26.52

Vasectomy status

V26.9

Unspecified procreative management

57170

Diaphragm/cervical cap fitting

58300

IUD insertion

58301

IUD removal

99070

Supply, diaphragm, IUD

J7300

IUD, copper (supply)

J7302

IUD, levonorgestrel (supply)

From World Health Organization (WHO). International Classification of Diseases (ICD-9).

IUD, Intrauterine device; OCPs, oral contraceptive pills.

about contraception that are easily elicited by open-ended questions. From this information, counseling can be customized to fit their specific needs. Use of their own words, frequent questions and answers, and feedback from patients play an important role in future compliance with medical advice.

An important consideration in contraceptive counseling is age because fertility among women varies with age. Barrier methods and some hormonal contraceptives can have low compliance in adolescents (ACOG, 2009). Older women can have more complications during pregnancy, making contraception an important component of health maintenance. Older women who are obese, smoke, or have comorbidities (e.g., hypertension, diabetes, migraines) are not good candidates to take combined hormonal contraceptives; progestin-only methods, intrauterine devices (IUDs) and sterilization may be good alternatives (Kaunitz, 2008). Women who use combined hormonal contraceptives after age 40 can be encouraged to stop in their early to mid-50s, when the likelihood of ovulation is low (ACOG, 2006).

Smoking is another important variable to consider when counseling patients. All patients should be encouraged to avoid smoking or to quit if they are smoking. The use of combined hormonal contraceptives in women over age 35 who smoked more than 15 cigarettes per day is contraindicated due to the increased risk of serious cardiovascular effects (Kroon, 2007). All women should be encouraged to use condoms consistently to reduce risk of sexually transmitted infections (STIs), especially in younger women with an increased risk of STI exposure.

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