Medical Coding II

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?