pregnancy and trauma

katysuegood@gmail.com

It is my understanding that pregnancy trumps other diagnoses.
a. General Rules for Obstetric Cases

1) Codes from chapter 11 and sequencing priority

Obstetric cases require codes from chapter 11, codes in the range 630-679, Complications of Pregnancy, Childbirth, and the Puerperium. Chapter 11 codes have sequencing priority over codes from other chapters. Additional codes from other chapters may be used in conjunction with chapter 11 codes to further specify conditions. Should the provider document that the pregnancy is incidental to the encounter, then code V22.2 should be used in place of any chapter 11 codes. It is the provider's responsibility to state that the condition being treated is not affecting the pregnancy.


However, we recently had a patient admitted s/p MVC with a Lis-franc fx. She was 18wks pregnant. We sequenced the pregnancy first but the Coder sequenced the injury first and her feedback was
“Reporting Injury codes as principle since procedure and focus of treatment was on injuries sustained in MVC. Would have coded pregnancy as incidental but fetal monitoring was administered and no complications to pregnancy were documented so will report 648.93 as secondary.”

The MD never stated that the pregnancy was ‘incidental’

Thoughts?

Katy Good, RN, BSN, CCDS, CCS
Clinical Documentation Program Coordinator
AHIMA Approved ICD-10CM/PCS Trainer
Flagstaff Medical Center
Kathryn.Good@nahealth.com
Cell: 928.814.9404

ddouthit

I have always been instructed that unless the physician deems pregnancy incidental that a pregnancy code is always assigned as principal. In this case, I would code 648.93 as principal and fx secondary. Per Guidelines Chapter 11 codes have sequencing priority over codes from other chapters.

Did this go to the coding manager for review?

Dorie Douthit RHIT,CCS
ddouthit@stmarysathens.org

ssalinas

This CC does not deal directly with the details of your example but it does reinforce the 'pregnancy code priority coding guideline'.

COPD with acute exacerbation occurring post-partum

Coding Clinic, First Quarter 2009 Page: 17 Effective with discharges: March 27, 2009
Question:

The patient is 37-year-old woman who was admitted five-weeks post-partum for treatment of an acute exacerbation of chronic obstructive pulmonary disease (COPD)/asthma. The patient had an uncomplicated pregnancy and delivery. She has anemia and hypertension and a past history of tobacco abuse. The obstetric coding guidelines seem to imply that any condition occurring during pregnancy, childbirth, or the puerperium is considered to be a complication unless the attending physician specifically documents that it not. Since the COPD is a pre-existing condition, would a chapter 11 obstetric code be assigned? How should this case be coded?

Answer:

Assign code 648.94, Other current conditions classifiable elsewhere, postpartum condition or complication, to identify that the patient's condition occurred during the postpartum period. The postpartum period begins immediately after delivery and continues for 6 weeks following delivery. Any condition occurring during pregnancy, childbirth, or the puerperium is considered to be a complication unless the provider specifically documents that it is not.

Assign code 493.22, Chronic obstructive asthma, with (acute) exacerbation, code 648.24, Other current conditions in the mother classifiable elsewhere but complicating pregnancy, childbirth, or the puerperium, Anemia, postpartum condition or complication; code 285.9, Anemia unspecified; code 642.94, Unspecified hypertension complicating pregnancy, childbirth, or the puerperium, postpartum condition or complication; and code V15.82, History of tobacco use, as additional diagnoses.






Sharon Salinas, CCS
Barlow Respiratory Hospital
2000 Stadium Way, Los Angeles CA 90026
Tel: 213-250-4200 ext 3336
ssalinas@barlow2000.org

katysuegood@gmail.com

I will be sending it Dorie. I just wanted to run it by my 'panel of experts' first

Katy Good, RN, BSN, CCDS, CCS
Clinical Documentation Program Coordinator
AHIMA Approved ICD-10CM/PCS Trainer
Flagstaff Medical Center
Kathryn.Good@nahealth.com
Cell: 928.814.9404