Obstetric Delivery Procedure Coding Guide

1. Congratulations It’s a 10E0XZZ

2. Objectives • Identify basics of obstetric delivery procedure coding • Understand which procedures are coded in Obstetrics section in PCS • Ability to assign correctly delivery and lacerations obstetrical procedures

3. Products of Conception (POC) • The only procedures that are coded in the OB section are done on products of conception. First character 1 • Products on conception include • Fetus/embryo • Aminotic fluid • Fetal blood • Retained products of conception • Endometrium following abortion or delivery • Umbilical cord • Placenta

4. Determine if it is a product of conception • Simply if the body part belongs to the female patient when she is not pregnant, the body part is not a product of conception, and it should be coded in the Medical and Surgical Section • Examples: • OB lac repair, BTL, cerclage of the cervix

5. Root Operations unique to OB • Abortion: definition- artificially terminating a pregnancy • Delivery: definition- assisting the passage of products of conception from the genital canal

6. Offical Coding Guidelines C1. Procedures performed on the POC are coded to the OB section. Procedures performed on the pregnant female other than POC are coded to the appropriate root operation in the Medical & Surgical section C2. Procedures performed following a delivery or abortion for curettage of the endometrium or evacuation of retained POC are all coded in the OB section, to the root operation Extraction and the body part POC, retained. Diagnostic or the therapeutic dilation and curettage performed during times other than the postpartum or post-abortion period are coded in the Medical & Surgical section to the root operation Extraction and the body part Endometrium.

7. Delivery of fetus • PCS defines delivery of the fetus into two sections of the OB section • Can be viable fetus or nonviable POC • Extraction: pulling or stripping out or off a portion of body part the use of force • 3rd character D • Includes: c-sections, forceps and internal version • Delivery: assisting the passage of POC from the genital canal • 3rd character is E • Always an external approach • No device or qualifier

8. C-section Build a code- 1 Obstetrics 0 Pregnancy D Extraction 0 Open Z No device ? 0- classical 1- low cervical

10. Forceps

11. Forceps design • Two are two crossing branches • Each branch has 4 parts • Blade • Shank • Lock • Handle • Each blade has two curves • One corresponds to the rounded head of the fetus • Second one corresponds to the upward pelvic curve and the axis of the birth canal • Some blades have openings (fenestrated) or depressions (pseudofenstrated) • The blade modifications allow for firmer grasp of the fetal head

12. Fetal station Fetal station is the relationship between the presenting part of the fetus body (head, shoulder, buttock or feet) and two parts of the mother called the ischical spine

13. Fetal Station • Above the ischial spine • It is reported with -1 to -5 • Each number is approximately 1 cm • Below the ischial spine • It is reported with +1 to +5 • Each number is approximately 1 cm

14. Vacuum Extraction • Vacuum extraction is Qualifier or 7th character of 6 • Code assign of delivery with vacuum extraction • 10D07Z6 • Vacuum assisted C-section • Coding Clinic 4th quarter 2014 pg 43 • Vacuum extraction to assist during c-section is include and no code seperately

16. Abortion • 3rd character A • Only applies to artificially terminated pregnancies • Subdivided into device used or no Device • Laminaria • Abortifacient • Vacuum • Mechanical

17. Abortion PCS table

18. Episiotomy • 0W8NXZZ- see the division of the perineum female • Not a product of conception; so the codes are located in the Medical & Surgical section • If the episiotomy extends to include a laceration, code both the episiotomy and the repair of the laceration

19. Female Anatomy

20. Lacerations • 1st degree tears- involve damage to the fourchette, vaginal mucosa and the underlying muscle are exposed but not torn • 2nd degree tears- include the posterior vaginal walls and perineal muscles, but the anal sphincter is intact • 3rd degree tears- extend to the anal sphincter, but the rectal mucosa is intact • 4th degree tears- involve the rectal and anal mucosa

21. Muscle layers in OB lacerations • B 3.5 states if a muscle layer is performed and it involves overlapping layers code to the deepest level • OB lacerations do not involve products of conception so should be coded in the Medical & Surgical section • 3rd and 4th degree laceration repairs, currently, will change the DRG to a surgical DRG

22. Lacerations • CC, 4th quarter 2013, pg 120, “… In ICD-10-PCS and ‘Open Approach” is defined as cutting through the skin or mucous membrane and any other body layers necessary to expose the site of the procedures. In this case, “open approach: is assigned because the laceration has cut through the external body layers exposing the muscle (ie the site of the procedure) Although the laceration occurred spontaneously, it is nevertheless the means by which the procedure site is exposed.”

23. Clitoral laceration • CC, 4th quarter 2014, pg 120-121, if the laceration includes only the clitoris the code would be 0UQJXXZZ, • Female vulva includes these structures: mons pubis, labia major, labia minora, clitoris, vestibule of the vagina, greater and lesser vestibular glands, vaginal orifice • Use the body structure vulva if the laceration includes other lacerations of the above structures.

24. Thank you