1. Medical Coding II
Seminar 6

2. 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

4. Coding the Mom’s Record

5. Index Entries Pregnancy Labor Delivery
Puerperium, puerperal, or postpartum
Many indentations under each term
Requires close attention to index entries

6. 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

7. 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

8. 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

9. 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

10. 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

12. 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

13. 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

14. 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)

15. 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

16. 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

17. 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

18. 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

19. 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

20. Coding the Baby’s Record

21. 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

22. 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

23. 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

24. 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

26. Questions?