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Basic ICD 10-CM/PCS and ICD-9-CM Coding, 2015 Edition

Basic ICD 10-CM/PCS and ICD-9-CM Coding, 2015 Edition. Chapter 14 : Complications of Pregnancy, Childbirth , and the Puerperium. Learning Objectives. Review the chapter’s extensive learning objectives

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Basic ICD 10-CM/PCS and ICD-9-CM Coding, 2015 Edition

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  1. Basic ICD 10-CM/PCS and ICD-9-CM Coding, 2015 Edition Chapter 14: Complications of Pregnancy, Childbirth, and the Puerperium

  2. Learning Objectives • Review the chapter’s extensive learning objectives • Concepts in this chapter may require extra study time and coding of conditions related to pregnancy is more difficult than other chapters of ICD-9-CM • Coding of obstetrical conditions requires special attention to definitions and details • At the conclusion of this chapter, what must you know about pregnancy, childbirth and the puerperium to code these conditions and the related therapeutic procedures?

  3. Chapter 11 of ICD-9-CM • ICD-9-CM codes describe conditions occurring in the pregnant female • Ectopic molar pregnancy (630–633) • Other pregnancy with abortive outcome (634– 639) • Complications mainly related to pregnancy (640–649)

  4. Chapter 11 of ICD-9-CM (continued) • ICD-9-CM codes describe conditions occurring in the pregnant female • Normal delivery, and other indications for care in pregnancy, labor, and delivery (650–659) • Complications occurring mainly in the course of labor and delivery (660–669) • Complications of the puerperium (670–677) • Other maternal and fetal complications (678–679)

  5. ICD-9-CM OB Coding Guidelines • Review ICD-9-CM official coding guidelines concerning obstetrics • Obstetric patients require codes from chapter 11 • ICD-9-CM Chapter 11 codes take sequencing priority over codes from other chapters • Additional codes from other ICD-9-CM chapters may be used with chapter 11 codes

  6. ICD-9-CM Diagnosis Coding of Abortion • Definition the ICD-9-CM diagnosis of abortion • Expulsion or extraction from the uterus of all or part of the products of conception: • Embryo or nonviable fetus weighing less than 500 grams OR • Estimated gestation of less than 22 completed weeks • When a fetus’s weight cannot be determined, an estimated gestation of less than 22 completed weeks is considered an abortion

  7. ICD-9-CM Coding of Procedure of Abortion • The procedure referred to as an “abortion” is more precisely described as: • Dilation and curettage • Dilation and evacuation • Aspiration curettage

  8. ICD-9-CM Diagnosis of Abortion • Fourth digits used with categories 634–638 describe presence or absence of complication such as: • Infection, hemorrhage, or organ or tissue damage • Renal failure, metabolic disorder, or shock • Embolism or other specified complication • Unspecified complication • Without mention of complication

  9. ICD-9-CM Diagnosis of Abortion (continued) • Fifth digits used with categories 634–637 • 0 unspecified • 1 incomplete • Expulsion of some, but not all, of the products of conception from the uterus—if the placenta or secundines remain, the abortion is considered incomplete • 2 complete • Expulsion of all the products of conception from the uterus prior to the episode of care

  10. Complications or Cause of Abortion • Codes from ICD-9-CM categories 640–649 and categories 651–657 may be used as an additional code with an abortion code to indicate the complication that resulted in the abortion • Fifth digit of 3 is used with the ICD-9-CM code(s) 640–649 and 651–657 to indicate the cause of the abortion

  11. ICD-9-CM Category 639 • Complications following abortion, ectopic, and molar pregnancies • This is a separate episode of care • Abortion, ectopic, and molar pregnancy has been treated at a previous episode of care

  12. ICD-9-CM Category 639 (continued) • ICD-9-CM category 639 codes are used for two different situations: • The complication itself was responsible for an episode of medical care ─the abortion, molar pregnancy, or ectopic pregnancy itself having been dealt with at a previous episode; **OR** • There are immediate complications of ectopic or molar pregnancies coded to 630–633 that cannot be identified at the fourth-digit level

  13. ICD-9-CM Category 639 (continued) • Fourth digit categories in ICD-9-CM are the same as those in 634–638 • ICD-9-CM category 639 code(s) cannot be assigned with a code from categories 634–638 • Categories 634–638 are the first episode of care • Category 639 is the second episode of care

  14. Early Onset of Delivery • ICD-9-CM code 644.21 = Woman delivered a premature liveborn infant • Less than 37 completed weeks of gestation • Any spontaneous or other abortion (infant less than 500 grams or less than an estimated 22 weeks of gestation) that produces a liveborn infant is coded to 644.21 • ICD-9-CM categories 634–638 cannot be used when a liveborn infant is the result

  15. Missed Abortion • ICD-9-CM Code 632 • Fetus died in utero before completion of 22 weeks’ gestation, with fetus retained in the uterus • Physicians may describe the condition as: • Empty gestational sac, blighted ovum, fetus or fetal pole without a heartbeat prior to completion of 20 weeks 0 days of gestation • Missed abortions are completed medically or surgically by physician intervention as soon as diagnosis is certain

  16. Threatened Abortion • ICD-9-CM code 640.0 with a fifth digit • Occurs before the 22nd completed week of gestation • Intrauterine bleeding, with or without uterine colic, without expulsion of the products of conception, without dilatation of cervix, so pregnancy continues

  17. ICD-9-CM Coding of Recurrent Pregnancy Loss • Three or more consecutive pregnancies that result in a spontaneous expulsion of dead or nonviable fetus at about the same period of development • Also known as habitual or recurrent abortion • In pregnant woman (ICD-9-CM 646.3 with fifth digit) • In woman with history of abortions but not currently pregnant (ICD-9-CM 629.81) • Admission for recurrent abortion, usually ICD-9-CM category 634 but may also be categories 635–638

  18. ICD-9-CM Coding of Pregnancy • Pregnancy is the state of a female after conception until birth (delivery) of the child • Normal pregnancy is intra-uterine (inside uterus) • Duration of pregnancy from conception to delivery is about 266 days

  19. Terms of Pregnancy in ICD-9-CM • Preterm: Delivery before 37 completed weeks of gestation • Term: Delivery between 38 and 40 completed weeks • Postterm: Delivery between 41 and 42 completed weeks • Prolonged: Delivery after 42 completed weeks

  20. ICD-9-CM Alphabetic Index Entries • Pregnancy • Labor • Delivery • Puerperium, puerperal, or postpartum • Many indentations under each term • Requires close attention to index entries

  21. ICD-9-CM Classification of Pregnancy • ICD-9-CM categories: • 633, Ectopic pregnancy • 640–649, Complications mainly related to pregnancy • 650–659, Normal delivery and other indications for care • 660–669, Complications: labor and delivery • 670–677, Complications of the puerperium • 678–679, Other maternal and fetal complications

  22. ICD-9-CM Coding Guidelines for Coding the Pregnant Patient • Obstetrical patients require a code from 630–679 from chapter 11 of ICD-9-CM • If patient’s treatment is not affecting the pregnancy, assign code V22.2, rather than a code from chapter 11 • Physician is responsible for documenting that a condition is not affecting the pregnancy

  23. ICD-9-CM Guidelines for Sequencing of Codes Related to Pregnancy • Principal diagnosis selection • Circumstances of the encounter or admission determine the principal diagnosis • If no delivery, principal diagnosis should identify the principal complication that necessitated the admission • When delivery occurs, principal diagnosis should identify the main circumstance or complication of the delivery

  24. ICD-9-CM Sequencing of Codes (continued) • Principal diagnosis selection • If a cesarean delivery was performed, principal diagnosis should reflect the reason for the admission (which may not be the reason for an unplanned or emergency cesarean delivery)

  25. ICD-9-CM Sequencing of Codes (continued) • Principal diagnosis selection • Routine prenatal visits without the presence of any complication • V22.0, Supervision of normal first pregnancy • V22.1, Supervision of other normal pregnancy • V22.0 or V22.1 are not used with additional codes from chapter 11

  26. ICD-9-CM Sequencing of Codes (continued) • Principal diagnosis selection • Prenatal visits in high-risk pregnancy • Code from category V23, supervision of high-risk pregnancy, should be sequenced first • Additional codes from chapter 11 should be assigned to describe specific complication

  27. ICD-9-CM Coding of Ectopic Pregnancy • ICD-9-CM Code 633 with fourth digit to indicate site • A pregnancy arising from implantation of the ovum outside the uterine cavity • Majority of ectopic pregnancies occur in a fallopian tube • Other ectopic pregnancies occur in ovary, peritoneum, abdominal viscera, cervix

  28. ICD-9-CM Fifth-Digit Subclassification for Pregnancy Codes • Assignment of fifth digit describes the episode of care • Fifth digits required for the following categories • 640–649 • 651–659 • 660–669 • 670–676 • 678–679

  29. Fifth-Digit Subclassification in ICD-9-CM (continued) • 0—unspecified as to episode of care or not applicable • 1—delivered, with or without mention of antepartum condition • 2—delivered, with mention of postpartum complication (complication developed after delivery but before woman was discharged from hospital)

  30. Fifth-Digit Subclassification in ICD-9-CM (continued) • 3—antepartum condition or complication • may be described as “undelivered” • 4—postpartum condition or complication • woman delivered during earlier episode of care

  31. Fifth-Digit Subclassificationin ICD-9-CM (continued) • Fifth digit of 0 should not be used if at all possible, find out more about the patient • When delivery has occurred during current episode of care, fifth digit is either 1 or 2 • Fifth digit of 1: Patient delivered, may or may not have had an antepartum condition • Fifth digit of 2: Patient delivered and developed a complication after delivery but before discharge

  32. Fifth-Digit Subclassificationin ICD-9-CM (continued) • Fifth digit of 3 • Delivery has not occurred during this episode of care • Patient remains pregnant; undelivered • Fifth digit of 4 • Delivery has occurred during a previous episode of care • Patient care is occurring less than 42 days after delivery and a postpartum condition exists

  33. Fifth-Digit Subclassificationin ICD-9-CM (continued) • Fifth digits of 1 and 2 can be used on different codes for the same episode of care as both indicate a delivery has occurred but complication developed at different times • Fifth digit of 3 can only be used with other codes with fifth digit of 3 • Fifth digit of 4 can only be used with other codes with fifth digit of 4

  34. Normal Delivery (ICD-9-CM Category 650) • Code 650 is assigned when all criteria are met • Full-term pregnancy • Single liveborn infant • Vaginal delivery with cephalic presentation • No fetal rotation • No use of instruments • No complications present at time of delivery or occurring after delivery but before discharge

  35. Normal Delivery (ICD-9-CM Category 650) (continued) • Code 650 cannot be assigned with another chapter 11 obstetrics code • Codes from other chapters may be used with 650 if condition is not related or complicating the pregnancy • Code 650 is always principal diagnosis • V27 category code is used with 650 • No fourth or fifth digit assigned

  36. Normal Delivery (ICD-9-CM Category 650) (continued) • The following procedures can be reported with code 650 • 73.09, Artificial rupture of membranes • 73.59, Other manually assisted delivery • 73.6, Episiotomy with repair • 75.34, Other fetal monitoring • 03.91, Injection into spinal canal, anesthetic • 66.21–66.29, 66.31–66.39, for sterilization

  37. Outcome of Delivery (ICD-9-CM Category V27) • Code from category V27 is used on all maternal records when a delivery has occurred • Always an additional code • Main term in Alphabetic Index: Outcome of delivery

  38. ICD-9-CM Coding of Obstetrical Complications • Pre-existing conditions may complicate the pregnancy, as well as condition is being aggravated by the pregnancy • Complication is described by chapter 11 code, which may completely describe both pregnancy and complication • A secondary code may be needed to add specificity about the condition

  39. Obstetrical Complications (continued) • ICD-9-CM Category 642, Hypertension complicating pregnancy, childbirth, and the puerperium • Fourth digit describes the type of hypertension • A secondary code from ICD-9-CM category 401, Hypertension, is not needed

  40. Obstetrical Complications (continued) • ICD-9-CM category 643, Excessive vomiting in pregnancy • Codes 643.0–643.2 completely describe the condition • Code 643.8 requires a second code to specify the cause

  41. Obstetrical Complications (continued) • ICD-9-CM category 645, Late pregnancy • Pregnancy is considered post term from 40 completed weeks to 42 completed weeks • Pregnancy is considered prolonged after 42 completed weeks • Potential high risk for complications

  42. Obstetrical Complications (continued) • ICD-9-CM categories 646–649 • Most codes require an additional code to further specify the condition, such as: • Type of diabetes • Type of renal disease • Type of infection • Type of mental disorder or substance dependence

  43. Obstetrical Complications (continued) • ICD-9-CM category 648, other conditions the woman has that can complicate the pregnancy • Diabetes 648.0x • Gestational diabetes 648.8x • Drug dependence 648.3x • Congenital and other cardiovascular disorders 648.5x, 648.6x

  44. Obstetrical Complications (continued) • ICD-9-CM category 649, other conditions or status of the mother complicating pregnancy, childbirth, or the puerperium. Some require the use of an additional code for specificity. • Tobacco use, 649.0x • Obesity, 649.1x • Bariatric surgery status, 649.2x • Coagulation defects, 649.3x • Epilepsy, 649.4x • Spotting complicating pregnancy, 649.5x • Uterine size date discrepancy, 649.6x • Cervical shortening, 649.7x

  45. Obstetrical Complications (continued) • Codes in ICD-9-CM category 670, major puerperal infections • Puerperal endometritis • Puerperal sepsis • Puerperal septic thrombophlebitis • Other infections such as pelvic cellulitis or peritonitis • Fifth-digits of 2 and 4 to reflect the episode of care as occurring in the puerperium

  46. Obstetrical Complications (continued) • Codes in ICD-9-CM category 671, Venous complications in pregnancy, are specific enough and no additional code is required • Most codes in ICD-9-CM categories 673–676 are specific enough and no additional code is required • Exception is ICD-9-CM code 674, Cerebrovascular disease, which requires an additional code

  47. Obstetrical Complications (continued) • Fetal medicine codes in ICD-9-CM categories 678–679 • Codes describe care provided to mother as well as the unborn fetus • ICD-9-CM category 678 describe fetal hematologic conditions and fetal conjoined twins • ICD-9-CM category 679 identify maternal and fetal complications from in-utero procedures

  48. ICD-9-CM Classification of Labor and Delivery • First stage (stage of dilation) • Onset of regular uterine contractions until cervical os is completed dilated • Second stage (stage of expulsion) • Cervical os is flush with the vagina completing the birth canal until the expulsion or delivery of the infant is completed

  49. ICD-9-CM Classification of Labor and Delivery (continued) • Third stage (placental stage) • From the expulsion of the child until the placenta and membranes are expelled • Fourth stage (1–2 hours after delivery) • The hour or two after delivery when uterine tone is re-established

  50. ICD-9-CM Coding of Obstetrical Procedures • ICD-9-CM Volume 3 Categories • Main term is delivery or other procedure title • Category 72, Forceps, vacuum, and breech delivery • Category 73, Other procedures inducing or assisting delivery • Category 74, Cesarean section and removal of fetus • Category 75, Other obstetric operations

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