OB Principal Diagnosis not POA

Coonan6@gmail.com

I have done very few OB reviews and am trying to understand how a principal diagnosis can be not POA. The patient was admitted for induction of labor. She had advanced maternal age. The patient had a vaginal delivery but complicated by a 4th degree laceration. Subsequently she had a postpartum hemorrhage. She had a D&C and the path report said everything was intact. An hour or two after the D&C she was still bleeding and ended up having a hysterectomy. The coder put the 4th degree laceration as the PDX not present on arrival. I emailed the higher ups and was told that the complication of the delivery is the pdx not POA and it is not unusual for OB charts to have the PDX as not POA. Can someone please explain why that is. I was taught that the pdx has to be POA. After looking through this forum, I understand that in some combo codes a section of that code may not be POA and can still be used as the PDX. Thank you for your help

Theresa Coonan BSN, RN, CCDS 

Margaret_Foley

Hi Theresa. 

See Official Coding Guidelines I.C.15.n. Normal Delivery Code O80 and I.C.15.b.2 2) Supervision of High-Risk Pregnancy.

If the patient did not have the laceration or the hemorrhage, the code for normal delivery O80 would be assigned.  However, if any other codes from Chapter 15 are assigned, the O80 may not be used (Guideline I.C.15.n.

The patients advanced maternal age is not coded.  (Guideline I.C.15.b.2 2)

Therefore, the only diagnoses to code are the laceration and hemorrhage neither of which were present on admission.

Hope this makes sense. 

Maggie

morris-jeff@CooperHealth.edu

Check out this article written by ACDIS Advisory Board member Dr. Erica Reemer, there are several parts of the article.

https://www.icd10monitor.com/ob-coding-delivering-accurate-coding-remains-a-challenge-part-ii

The Official Guidelines for Coding and Reporting direct you to choose the complication of the delivery as the PDX.

Jeff

mlbuntze

Theresa, I code OB as primary.   What was the dx for induction?
Marjie
Pavilion For Women/ Texas Childrens Hospital
Houston Texas 
832-824-4603

rmhosler1

OB can be very tricky. I tell myself that what we code is also used for data tracking. If something other than a routine delivery happens that will most likely be pdx. Of course based on the above guidelines but that is how I get it straight in my head. Hope that helps. Mary 
 
 

Sarah.price

ICD-10-CM Official Guidelines for Coding and Reporting:

When an obstetric patient is admitted and delivers during that admission, the condition that prompted the admission should be sequenced as the principal diagnosis. If multiple conditions prompted the admission, sequence the one most related to the delivery as the principal diagnosis. A code for any complication of delivery should be assigned as an additional diagnosis.

The above guideline applies to vaginal delivery, guidelines for cesarean delivery are slightly different.

Coding deliveries can be difficult and sometimes it is not possible to code according to the guidelines. Consider the case of a woman with a full term gestation admitted in labor, membranes intact. Her labor progresses without intervention and she has a vaginal delivery, complicated only by a first degree perineal laceration. There is NO code for the condition which prompted the admission - labor - and you can't sequence the Z code for the number of weeks gestation as principal, so the only option in this case is to sequence the laceration as principal.

It is true that when coding OB records, oftentimes the principal diagnosis will not be POA.

Coonan6@gmail.com

Thank you to everyone that responded.  I appreciate the information and pointing me in the right direction for more education.