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Chapter 6

Chapter 6. Pregnancy and Related Conditions. Chapter 11, Complications of Pregnancy, Childbirth, and Puerperium. Extensive multiple coding with many fifth digit assignments and notes Chapter 11 codes take precedence over codes from other chapters Admission for pregnancy, complication

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Chapter 6

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  1. Chapter 6 Pregnancy and Related Conditions

  2. Chapter 11, Complications of Pregnancy, Childbirth, and Puerperium • Extensive multiple coding with many fifth digit assignments and notes • Chapter 11 codes take precedence over codes from other chapters • Admission for pregnancy, complication • Obstetric complication = first-listed diagnosis

  3. Section I.C.11. Complications of Pregnancy, Childbirth, and Puerperium • Chapter 11 codes • Mother’s medical record(600 series codes) • Not on newborn medical record (Newborn, 700 series codes) (Cont’d…)

  4. Section I.C.11. Complications of Pregnancy, Childbirth, and Puerperium (…Cont’d) • Mother’s record • Outcome of delivery code (V27.0-V27.9) when delivered

  5. Section I.C.11.a. General Rules for Obstetric Cases • Not all encounters are pregnancy related • Example, pregnant woman, broken ankle • Broken ankle • V22.2 Pregnant state incidental must be documented in medical record treated condition not affecting pregnancy

  6. Section I.C.11.a.4. Fifth Digit • All categories EXCEPT 650 (Normal delivery) • Requires fifth digit for: • Antepartum • Postpartum • Delivery

  7. Codes 640-676.9 Share Fifth-Digit Subclassification • Denotes current episode of care • 0 Unspecified as to episode of care or not applicable • 1 Delivered, withor without mention of antepartum condition • 2 Delivered, with mention of postpartum classification • 3 Antepartum condition or complication • 4 Postpartum condition or complication

  8. Section I.C.11.b. Selection of Principal Diagnosis—Obstetric • No delivery: Principal diagnosis = principal complication • >1 complication, sequence any first (Cont’d…)

  9. Section I.C.11.b. Selection of Primary Diagnosis (…Cont’d) • Routine prenatal visits no complications: • V22.0, Supervision, normal first pregnancy or • V22.1, Supervision, other normal pregnancy • Always primary diagnosis • Prenatal outpatient visits for high-risk pregnancies: • V23, Supervision of high-risk pregnancy (V23.X)

  10. Section I.C.11.c.1. Fetal Conditions Affect Mother • Codes from Categories 655 and 656 • Assign only if known or suspected fetal abnormality affects management of the mother • Requires additional diagnostic studies, observation, special care or termination of the pregnancy • The existence of a fetal condition alone does not justify reporting these codes

  11. Section I.C.11.c.2. In Utero Surgery • When surgery is performed on the fetus, report a code from Category 655 identifying the fetal condition • No code from Chapter 15, perinatal codes, should be used on the mother’s record to identify fetal conditions • Surgery performed in utero on the fetus is still coded as an obstetric encounter

  12. Section I.C.11.d. HIV Infection in Pregnancy, Childbirth, Puerperium • Patient admitted during this period because of an HIV-related illness should receive • a principal code of 647.6x • followed by 042 • Patient admitted with asymptomatic HIV status should be reported • 647.6x • V08

  13. Section I.C.11.e. Current Conditions Complicating Pregnancy • Assign a code from Category 648.x for patient with current condition that affects management of the pregnancy, childbirth or the puerperium • Use additional secondary code from other chapters to identify conditions

  14. Section I.C.11.f. Diabetes Mellitus in Pregnancy • Significant complicating factor in pregnancy • Diabetic pregnant patients should be assigned code 648.0x AND • A secondary code from Category 250 to identify type of diabetes • Code V58.67, Long-term (current) use of insulin should also be reported if appropriate

  15. Section I.C.11.g. Gestational Diabetes • Occurs in second and third trimester of women who were not diabetic prior to pregnancy • Can cause complications in pregnancy similar to those of pre-existing diabetes • Puts women at greater risk of developing diabetes after the pregnancy (Cont’d…)

  16. Section I.C.11.g. Gestational Diabetes (…Cont’d) • Report 648.8x • NEVER report codes 648.0x and 648.8x together • Code V58.67, Long-term (current) use of insulin should also be reported if gestational diabetes is being treated with insulin

  17. Section I.C.11.h. Normal Delivery, 650 • Nocomplications, principal diagnosis = 650 • With complications = NOT 650 • V27.0 (Single liveborn) • Only outcome for 650 (Normal Delivery) • Normal delivery with resolved antepartum condition = 650

  18. Section I.C.11.i.1. Postpartum Period • After delivery and continues for6 weeks

  19. Section I.C.11.i.2,3,4 Postpartum Complications • Any complication occurring within the 6-week period • Complications occurring after the 6-week period may be reported with Chapter 11 codes, if the provider documents they are pregnancy related • Complications occurring during the same admission as delivery are reported with fifth digit “2”; subsequent admissions/encounters with fifth digit “4”

  20. Section I.C.11.i.5 Care following delivery outside hospital • If deliveredprior to admission • In ambulance • At home • In ED • DO NOT CODE delivery • Code any postpartum care

  21. Section I.C.11.j. Late Effect of Complication of Pregnancy • Category 677 • Reported when an initial complication of pregnancy requires care or treatment at a future date • Category reported any time after initial postpartum period • Like all late effects, code is sequenced following the complicating condition

  22. Section I.C.11.k. Abortions • Codes 634-637 require fifth digits: • 0: Unspecified • 1: Incomplete(POC, product of conception) NOT expelled • 2: Complete, all (POC) expelled prior to care

  23. Section I.C.11.k.1. Fifth Digit • Appropriate fifth digit listed under each code • 640.0, Threatenedabortion • 0: Unspecifiedepisode • 1:Delivered with or without complication • 3: Antepartum condition or complication • Note that NOT all fifth digits are applicable (2 and 4)

  24. Section I.C.11.k.4. Abortion with Liveborn Fetus • Attempted abortion results in liveborn fetus: • 644.21 (Early onset of delivery) appropriately • UseV27 (Outcome of delivery) • Attempted abortion procedure code also assigned

  25. Section I.C.11.k.5. Retained Products of Conception • Subsequent admissions for retained products of conception following a spontaneous or legally induced abortion are reported with code from: • 634 Spontaneous abortion • 635 Legally induced abortion • With fifth digit “1” (incomplete) • Appropriate even if patient previously discharged with diagnosis of “complete”

  26. Chapter 6 Conclusion – Pregnancy and Related Conditions

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