Okay, let’s look at another one. This is exercise 24.4 #9. And this is a pregnancy
complicated by abruptio placentae. And I looked that up. That is a premature separation of
the placentae either partially or totally from the uterus. Separation of the placentae
from the uterus, coming significant third trimester bleeding associated with fetal and
maternal morbidity and mortality. The morbidity and mortality to the fetus because of decreased
oxygen. If the placentae is where how the baby gets oxygen, and also nutrients are deprived,
and maternal, because of severe bleeding, it can be morbidity and mortality for her.
There’s uteral detraction, there’s fetal distress, and bleeding, of course. Okay, so
here we’ve got the term pregnancy, so it’s not preterm, delivered a single stillborn,
left occipitoanterior terminal abruptio placentae; chord wrapped tightly around the neck with
compression. It does not call this chord with compression anuchal, A N U C H A L, chord,
but I have seen that in medical records. It means the same thing. I am not clear what
the left occipitoanterior refers to, in this case. But based upon the codes that were in
the answer key that I had, we don’t – it doesn’t affect our code assignment. So,
you can see here, I have bullet points for the different conditions we’re going to
code. The pregnancy complicated by the abruption placentae. The Delivery complicated by the
cord wrapped around the baby’s neck. Because the baby died, we’re going to have that
maternal care for intrauterine death. The outcome of the delivery, being a single child
– single infant with stillborn, and the weeks of gestation, 39. The first code is
the pregnancy complicated by the abruption placentae, and you can see that it takes you
completely out of the pregnancy codes, which I find so interesting. Not sure why that is.
Because when you go to the abruption placentae in the index, it takes you right back to Chapter
15. So, I’m not clear why it makes that distinction in the index, but it does. And
we look at the tabular, we see that we need a fifth character to assign the trimester,
in this case, it’s the third trimester, so our final code 045.93. Now, let’s look
at the second part. Delivery complicated by the cord around the baby’s neck. And it’s
pretty straight forward. Delivery complicated by cord around neck with compression. There
are codes without compression, so it is important that you notice that last phrase there. You
got another one of those pink boxes, telling you your seventh character, in this case,
the seventh character is telling us which fetus. We have a single fetus, so we’re
going to choose zero as our seventh character. And that takes care of our second bullet point.
Here, we have to also code maternal care for intrauterine death. The outcome of delivery
and the weeks of gestation. As I mentioned in the previous slide, anytime the baby dies,
maternal care is provided and you are coding pregnancy complicated by fetal death. There’s
the outcome of delivery: single stillborn. And pregnancy, weeks of gestation. Let’s
look at this one. An elderly primigravida, 37 years old. 40 weeks gestation, spontaneous
delivery, living female infant. Notice this time, it doesn’t say live born; it says
living. So, sometimes your words are a little bit different, but you know what they mean.
We’re going to code supervision – believe it or not, a woman who is 37 years old is
considered a high-risk pregnancy. So, that is why we fall into a special code here. Outcome
of delivery and the weeks of gestation here. And if you’re wondering about the definition
of a primigravida – let’s look at that. If you can’t remember the definition of
elderly primigravida, it’s right here, in the codebook. 35 and older. That delivery.
So, your sixth character is going to be your trimester. Primigravida is first pregnancy,
multigravida, other than first. Like, second, third, fourth, whatever. But the age being
35 years and older. I have this slide just to remind all of us, especially me, it’s
all in the numbers. It’s so important in the pregnancy chapter, the other chapter,
to know the numbers. So, wherever you need to write this down. I write on the page opposite
of my guidelines. I’ll show you in just a second. I’ll write definitions – just
things I need to remember. Preterm labor, any labor before 37 weeks, 37 completed weeks.
Post-term pregnancy is over 40 completed weeks to 42 – that’s a post-term. But when you
get beyond 42, now you’re talking about prolonged pregnancy. Can I make the note here
that whenever you are coding a spontaneous abortion, if the gestational age is beyond
20 weeks, you’re going to look up “delivery” in the index to get you to the correct code.
So here, in my code book, I want to show you where I have these written. This is chapter
15 in the codebook. And just opposite at the – it’s actually the end of the guidelines
for chapter 15. There’s a little bit of room there. So, I have written myself notes
like, get this up, “pre-term labor, post-term pregnancy, prolonged pregnancy,” just to
help me remember those numbers. And I also have a note to myself up here that whenever
you get a delivery chart, at a minimum, you’re going to have a delivery diagnosis, either
it’s going to be normal, or whatever complication there is. The outcome of delivery, the weeks
of gestation, and any procedures that are done. So, this is just a reminder to me, be
sure I’ve coded enough, whenever I’m coding a delivery chart. Okay, let’s look at a
couple that are not in the coding handbook. This is a spontaneous abortion of a single
fetus at 21 weeks. Complete. Complete, meaning a complete abortion. You have spontaneous
abortion, you can have a complete, meaning all the products of conception were expelled.
Or you can have an incomplete, where the body has retained some of the products of conception,
and you also have to have a D & C. Spontaneous abortion is really pre-term labor with pre-term
delivery. So, that helps you know how they’re going to code it. 21 weeks is the second trimester.
And then – if your gestational age is beyond 20 weeks, you’re going to look up delivery
instead of abortion. And the outcome of delivery, we have to code it, but you notice, it didn’t
tell us live born or not. But obviously, at 21 weeks, a fetus can’t survive. So a fetus
at 21 weeks would be stillborn. So, that’s how you get that Z37.1 code. So, here we got
– okay, so, here is the pathway for the pre-term labor, with delivery. Weeks of gestation,
and the outcome. Just make a little not here about clinical coding workout 2016, that’s
where I got this particular exercise from. If any of you plan on becoming coders, I recommend
that you get your hands on clinical coding workout, or something that gives you more
scenarios than we can do in this class. They’ll be more challenging, admittedly, but if it’s
something you really want to do – it’s a great way – this is how I keep my skills
up, for using things like that to find codes. Here’s another one. And this one’s a little
tricky. So, I wanted to be sure we covered it. Septic shock following incomplete spontaneous
abortion. When you go to the index, there’s an incomplete abortion, with sepsis and an
incomplete abortion with shock. But then when you go and you look up your codes, there’s
an excludes one note, this O03.31 code, which tells me you can’t use both of those together.
So, my conclusion is because the shock is due to the sepsis, I would assign the sepsis
code, which is the first one here. It also tells us to code the infectious agent, what
caused the sepsis if we know it. We aren’t given that. But we are told that the patient
has septic shock, and septic shock is classified to R65.21, and that would be your secondary
code. As always, be mindful that the exercises in this Power Point don’t address all of
the guidelines with chapter 15. I do expect you to know all those guidelines. Always follow
your assignment schedule with regard to specific chapter assignments, and please let me know
if you have any questions. I will do my best to answer them. Thank you so much.