Medical Coding II
Seminar 6
Unit 6 Overview
• Reading, Understanding ICD-9-CM Coding: Chapters 16, 19, 20
• Graded Assignments – Seminar, Attend Seminar or Complete Option
2, 20 Points– Exercises, Challenge exercises derived from
your textbook, 20 points– Quiz, 60 points
3
Mom’s Codes versus Baby’s Codes
• Health record for mother– Chapter 11 codes (630–677) are used to
describe the maternal conditions and reported only on mother’s record
– V27 category for outcome of delivery
• Health record for baby– V30 category for newborn status– Codes 760–763 and 764–779 identify
conditions of newborn
Coding the Mom’s Record
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Index Entries
• Pregnancy
• Labor
• Delivery
• Puerperium, puerperal, or postpartum
• Many indentations under each term
• Requires close attention to index entries
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Terms of Pregnancy
• Preterm: Delivery before 37 completed weeks of gestation
• Term: Delivery between 38 and 40 completed weeks
• Postterm: Delivery after 40 completed weeks through 42 completed weeks
• Prolonged: Delivery after 42 completed weeks
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Classification of Pregnancy
• 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
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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
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Sequencing of Codes
• 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
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Sequencing of Codes (continued)
• Principal diagnosis selection
• When delivery occurs, principal diagnosis should identify the main circumstance or complication of the delivery
• If a cesarean delivery was performed, principal diagnosis should reflect the reason for the admission
11
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
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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
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Fifth-Digit Subclassification
• Assignment of fifth digit describes the episode of care
• Fifth digits required• 640–649• 651–659• 660–669• 670–676• 678–679
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Fifth-Digit Subclassification (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)
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Fifth-Digit Subclassification (continued)
• 3 – antepartum condition or complication– may be described as “undelivered”
• 4 – postpartum condition or complication– woman delivered during earlier episode of care
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Fifth-Digit Subclassification (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
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Fifth-Digit Subclassification (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
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Fifth-Digit Subclassification (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
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Obstetrical Procedures
• Volume 3• 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
Coding the Baby’s Record
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Newborn Coding Guidelines
• Newborn period is defined as beginning before birth and lasting through the first 28 days after birth
• All clinically significant conditions noted on routine newborn examinations should be coded
• Physician documentation indicates whether a condition is clinically significant
Newborns, Congenital Anomalies and Perinatal Conditions
• Newborns may have congenital anomalies (740–759 ) and certain other conditions that originate in the perinatal period (760–779)
• Coding the birth of an infant– First code is from categories V30–V39 – Additional code from 740–759 and/or 760–
779 assigned for additional conditions
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Newborn Coding Guidelines (continued)
• A newborn condition is significant if it requires:– Clinical evaluation– Therapeutic treatment– Diagnostic procedures– Extended length of hospital stay– Increased nursing care and/or monitoring– If it has implications for future healthcare
needs
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Newborn Coding Guidelines (continued)
• Codes should be assigned for conditions that have been specified by the provider as having implications for future health care needs
• Codes from the perinatal chapter should not be assigned unless the provider has established a definitive diagnosis
25
Principal versus Additional Diagnosis
• Hospital stay at time of birth– Principal diagnosis in V30–V39 section– Additional diagnosis for congenital anomaly or
other condition such as prematurity
• Infant transferred to second hospital– Follow definition of principal diagnosis– Generally the reason for transfer, such as
anomaly, perinatal condition, or complication– V30–V39 is not used again
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Questions?
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