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Endometriosis K014

Last amended 
10 June 2015
Current RMA Instruments:
Reasonable Hypothesis SOP
41 of 2012
Balance of Probabilities SOP
42 of 2012
Changes from Previous Instruments:

SOP Bulletin 159

ICD Coding:
  • ICD-9-CM Codes: 617
  • ICD-10-AM Codes: N80

The endometrium is the inner layer of the uterus. In endometriosis endometrial tissue is found in an ectopic (out of place) location, that is, not in its normal location within the uterine cavity.

The SOP specifies that the ectopic endometrium must be causing clinical problems and or requires treatment. This condition normally provides a clinical presentation of abdominal pain or disordered menstrual bleeding. This is not a neoplastic or a malignant neoplastic condition.

Is specific diagnostic evidence required to apply the SOP?Yes.

This diagnosis is based on histology reports provided by a pathologist based on surgical biopsy or excision.

Are there sub-factors that require specific information? – Yes. 

The surgery/ trauma factor is site specific.  To apply this factor you need to know the site of the endometriosis.

Conditions excluded from SOP
  • Ectopic endometrial tissue that has not resulted in clinical manifestations.
Unconfirmed diagnosis

If, after applying the above information, you are unable to confirm the diagnosis, you should then seek medical officer advice about further investigation.