Hello today we're going to talk about chapters 24 and 25 from the coding handbook 2016 and
this corresponds to chapter 15 in the ICD-10-CM codebook you've heard me talk about chapter
15 the OB codes throughout the semester I've find them more challenging because I've not
worked in a hospital where I've coded OB so I think until you've have actually worked
in the field and done something with it you don't really feel comfortable with it so what
I have learned from OB I've learned from textbooks and attending lectures that type of thing
but until I'm really able to do it myself I don't think I'll have as much confidence
in myself as I would have otherwise and for that reason this is one of those chapters
I read the guidelines over and over to be sure that I understand them before I even
start coding an OB patient I would recommend you always read over your guidelines before
you start assignments especially with OB always go to the index to find those final character
codes so that you can be sure you're getting enough characters in the code not just what's
given to you in the index if you have trouble remembering the trimesters they are located
at the very beginning of the chapter in the code book and and often the codes requiring
a seventh character indicate the trimester they can mean other things as well but it's
very often you will have to assign a seventh character to indicate the trimester so let's
look at what I'm telling you in the beginning of the chapter you see here it reminds us
that we only use these codes on the mothers chart never on the babies and here are our
definitions of trimesters if you can remember 14 and 28 you're going to be pretty safe less
than 14 first trimester 14-28 second trimester and 28 forward till delivery third trimester
also an instructional note to use an additional code from category Z3A weeks of gestation
to identify the specific week of the pregnancy so any time you're using a code from chapter
15 you're going to be using a weeks of gestation identification code and also when you have
a delivery you're going to always code the outcome of that delivery that is a coding
guideline and here is thee code for outcome of delivery weeks of gestation must have been
an after thought or something I don't know but when you look for it in the code book
it's following Z36 for whatever reason so that's why it's sometimes a little bit difficult
to find but it does tell you in the index that it follow Z36 to help you find your place
in the code book seventh character can also be related to the fetus to identify the fetus
the seventh character zero is used whenever you have a single gestation the documentation
is insufficient you can't clinically determine which ones affected it's multiple but you
don't know you can't identify which fetus it's another one of those things you don't
have to remember that necessarily because it is in those little pink boxes near many
of the other category codes lets take a look at that it has an example of one of the pink
boxes I'm telling you about where it defines what zero might mean
and even though this one is following the 036 category code you'll see these same choices
for that seventh character associated with many codes not just this one we'll talk more
about that thru this podcast the selection of first listed and principal diagnosis you
can look at these in your guidelines a routine outpatient prenatal visit is assigned to the
Z34 category that is not used with chapter 15 codes it's just a routine prenatal encounter
not used with any complications or delivery codes very simple if you get into a prenatal
outpatient for high-risk patient now you're moving into thee 09 category and you can use
chapter 15 codes with this category I wanted to make a point to give you 2017 guidelines
that give more directions each year we have guidelines and they were published in August
late July or August for the fall they go into effect on October 1st so you see this is fall
2017 now you don't have to know these this will apply for the students who take this
course in the spring because your code book is going to be the 2016 version but I wanted
you to be aware of the fact that if you're working as a coder you're going to have to
keep up with any changes to the guidelines especially since ten is so new we are seeing
many changes to guidelines specifically more so with PCS than the diagnoses as well and
what they do is they publish them and then they will bold face the ones that are something
new so that the coder can know that this is something different it does say in your guidelines
that the categories from excuse me the codes from this category supervision of high risk
are for the pre-natal period but it's expanded now to say complications during labor and
delivery as a result of a high risk pregnancy you assign the complication codes from 15
chapter 15 if there's no complications it means you can assign O80 and encounter for
full-term uncomplicated delivery so what this tells me is even though you may have a high-risk
pregnancy that you have to monitor throughout the pregnancy you can have an uncomplicated
delivery that does allows you to assign an O80 code likewise a little bit further down
on the same page there's notes that talk about when the delivery occurs the condition that
prompted the admission should be sequenced as the principal and if multiple conditions
prompted admission you sequence the one most related to the delivery as the principal the
code for any complication of delivery should be assigned as an additional diagnosis again
this guideline exists but what the 2017 edition has done is expanded the guidelines to give
a little more explanation there are also episodes when no delivery occurs and when that happens
your principal diagnosis is going to correspond to whatever complication necessitated the
patient being in the hospital or being seen as an out patient or whatever reminder again
chapter 15 codes take precedence what that means is a veteran coder told me once for
a pregnant woman you assume anything that happens affects that pregnancy unless the
physician has documented otherwise lets say that again unless the physician has documented
otherwise you assume that the condition a woman comes into the hospital with is affecting
her pregnancy I mentioned earlier the O80 code there's certain criteria that has to
be met before this code can be used this is taken directly out of your handbook and I've
seen it on many tests not only my course but courses that I've taken because I think sometimes
we think completely normal delivery means no episiotomy no that's not what it means
we are told with or without an episiotomy you can use that normal delivery code but
if you have forceps or any fetal manipulation you can no longer use the O80 code any other
presentation other than cephalic or occipital cannot use O80 and has to be a single infant
twins or multiples you cannot use that code no complications either during delivery or
postpartum for that episode of care and this is an interesting fact I was reading through
some things and saw that category O60 and O77 contains some of the most important codes
for situations when you cannot use the O80 code
lets look now at some conditions that complicate pregnancy childbirth or the puerperium and
one of them is hypertension you notice that depending on how the maternal hypertension
is described there's a different category code pre-existing O1O gestational without
proteinuria O13 gestational with proteinuria or pre-eclampsia O14 eclampsia O15 and maternal
hypertension complicating pregnancy but unspecified O16 pre-eclampsia and eclampsia are very serious
I've seen both working in the hospital I was not a coder at that time I was a case manager
but I can recall the scariness of it the doctors would when a woman goes in especially if she
into eclampsia and starts having seizures it's very serious and I have seen fathers
quickly shuttled out of thee delivery room so that someone can attend to a mother who
is really having a shes in a life threatening situation okay lets do a few exercises this
is taken from the coding handbook exercise 24.4 number 2 intrauterine pregnancy 12 weeks
gestation undelivered with mild hyperemesis gravidarum I encourage you for any of these
terms you don't know that you use our Google search engine or whatever search engine you
want to use and look them up hyperemesis gravidarum is not uncommon in pregnancy it's a pretty
serious thing though it's caused by they think it's believed they believe it's caused by
rapidly rising HCG hormones in a woman�s body and it can make her have severe nauseas
vomiting really get her electrolytes off and use significant amount of weight I had a very
good friend that she only had two pregnancies both times she was hospitalized with this
she would just throw up and throw up so it does happen and I don't think it's uncommon
so I believe you would see it in this case I have the rationale and the pathway there
and the weeks of gestation captured so that's pretty straight forward as an example be a
little bit harder this is a cesarean delivery of a stillborn at 38 weeks owing to placental
infarction placental infarction placental infarction is not found in the index so when
you start looking for this code you are taken to placental disorder and you do know what
it is so I would used specified but a couple of times in this course I've told you about
those times when the index gets you in the neighborhood but not to the specific house
where you'd want to be so you have to go the Tabular and when you find this O43.89 if you
look above that you find O43.81 with the infarction so lets take a look at that so any time you
are given a .8 or a .89 code always look around just to see if there's something and it just
so happens in this particular case it's right above it's not always that easy but as I've
told you before you can never rely on the index to give you your final code you've got
to go to the Tabular and look what code the index has given you to be sure you're selecting
the right code and that sixth character the sixth character is the trimester okay lets
continue we know from our earlier slide we have to always code at code delivery in this
case it's a single stillborn so you're going to be selecting the Z37.1 code so lets look
at that so here's the Z37 code and you see how we're given so many choices single live
birth single stillbirth twins both live born twins both stillborn and then your multiples
and I have a note here that says exempt from POA reporting POA is present on admission
we'll talk about that more a little later on this semester but this is just my note
to myself but this is just to remind myself that we're not going to be reporting a POA
indicator for outcome of delivery whenever there is a fetal death you will code
this pregnancy complicated by fetal death O36.4 and you see here what we've had to use
the fifth and sixth character placeholders in order to assign the seventh character for
the fetus so there you go and here's the weeks of gestation ok lets look at one at one that's
a little bit more difficult I can move this up a little bit just a little bit huh okay
an intrauterine pregnancy twins 33 weeks premature rupture of the membranes with on set of labor
three hours later spontaneous delivery of premature twins vertex presentation both liveborn
postpartum pulmonary embolism couple of things come to my mind one is that I know that preterm
labor is definded as an onset an onset of labor before 37 weeks and this case it's a
33 week pregnancy so we're going to be coding preterm labor at some so I went through and
I looked at what was given to us and what we going to preterm rupture membranes with
preterm delivery you can have preterm rupture membranes without delivery so that's why you're
going to say with preterm delivery a premature rupture of membranes with onset of labor within
24 hours because there's choices to have codes that are more than 24 hours twin pregnancy
postpartum outcome of delivery of twins and weeks of gestation okay so lets start looking
at that uh o I went the wrong way what I am showing you here your textbook gave
O6O.14xO as the answer that is incorrect the publisher sent out what was called an errata
E-R-R-A-T-A which is something publishers send out after they have published a book
and it's been printed and they find an error and that error that was reported that was
because it was these were twins and each one had a premature labor was affected by premature
labor each one gets a code so seventh character one is fetus one and and character two is
fetus two so that's how you get these two codes and then here I added premature labor
for each to remind me that each one gets the code so now let's look at the next is thee
complication of the premature rupture with the onset of labor within 24 hour preterm
because we are before 37 weeks that gives us that O42 code and the final sixth character
in this case is the trimester and here is the last few codes where you have a twin pregnancy
anytime you have multiples you're going to be assigning a code a specific to that in
this case it was a twin it could be multiples and we were not told in the documentation
how many placenta or amniotic sacs there were so you're going to choose the less specific
O30.003 with the sixth character to indicate it was the third trimester O88 is the embolism
that was mentioned here the post partum embolism it's P-U-E-R-P-E-R-A-L and that is post partarum
so that's going to determine your final characters come to deliver twins both liveborn and your
weeks of gestation theres another one premature delivery third trimester with a frank breech
presentation single female liveborn first degree tear vaginal wall we know it's premature
so you've got preterm delivery third trimester because it was a breech presentation you have
maternal care you have a tear of the peritneam outcome of delivery single liveborn and weeks
of gestation in this case we're not given the third trimester only was given but that
does allow us to assign a specific code look at on the next page here is your pregnancy
complicated by preterm labor third semester with third semester preterm delivery the pink
box we mentioned earlier with seventh character the O the seventh character 0 is fine because
we've got one baby so that's correct now we're going to look at the breech presentation it
also allows us to assign a seventh character here is the explanation and here we go with
the perineum laceration the outcome of delivery and the pregnancy okay I'm going to stop there
and we will do part 2 to finish our