1 / 79

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

dnielson
Download Presentation

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

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  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

More Related