09-24-2026 IUD-What’s the Intent
Scenario:
- 01/15/2026 Endometrial bx-EIN (Endometrioid Intraepithelial Neoplasia) bordering well-differentiated endometrioid carcinoma.
- 01/15/2026/= GYN Onc Treatment plan: Hysterectomy as the standard of care approach. Medical management with progesterone (oral and/or Mirena IUD) for those who desire preservation of fertility or are not suitable candidates for surgery. The patient would like to proceed with medical management of this early-stage endometrial cancer. Recommended proceeding to the OR for a D&C to assess the entire uterine cavity and obtain additional tissue. At that time, recommended placement of LNG-IUD [levonorgestrel-releasing intrauterine device] for management of EIN
- 03/01/2026 Exam under anesthesia, cervical dilation, hysteroscopy, endometrial curettage, Levonorgestrel IUD insertion
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- Endometrial curetting’s: Foci of WD adenoca, endometrioid type, arising in background of endometrial intraepithelial neoplasia (EIN).
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- 04/01/2026 MRI pelvis-Homogeneous enhancement of the endometrium without discrete mass or myometrial invasion. IUD in the endometrial canal. No evidence of pelvic lad.
- 5/15/26 Gyn Onc: Reviewed with patient that the standard of care for this Early-Stage Endometrial cancer is surgery with hysterectomy, but that in select cases, fertility-sparing treatment can be carried out with close surveillance. LNG-IUD is in place as treatment. Repeat endometrial biopsy scheduled for July 2026
Question: How would you code the Levonorgestrel IUD insertion?
- Hormone-01
- Other Treatment-01
- Do not code, but list in text
Answer: Hormone-01
SEER*RX
Remarks
DO NOT CODE if Mirena IUD is used for pregnancy prevention or heavy menstrual bleeding (FDA approved indications).
CODE as hormonal therapy in patients with early stage endometroid carcinoma if given as fertility-spearing hormonal therapy.
Per clinical guidelines, fertility-spearing hormonal therapy alone can be used in selected patients (e.g. grade 1 endometroid carcinoma, disease confined to endometrium, no evidence for spread on imaging). Levonorgestrel IUD (Mirena), oral progestins or combination can be used
