Today, we’re going to talk about conditions originating in the perinatal period, which
is chapter 16.
And congenital malformations, deformations, and chromosomal abnormalities.
In chapter 17 in the ICD-10-CM codebook.
We’ll begin with chapter 16.
Codes in chapter 16 are never for use on the mother’s record.
Likewise, codes from chapter 15, the obi-chapter, are never permitted on the newborn record.
Chapter 16 codes can be used throughout the life of the patient, if the condition is still
present.
And for coding, and reporting purposes, the perinatal period is defined as before birth
through the 28th day following birth.
When a physician is talking about a premature infant, typically, they talk about the birth
weight and the gestational age of that infant versus using the term premature.
There are P05 and P07 categories that relate to low birth weight and gestational age.
Codes from P05 should not be assigned with category P07 codes.
And there is an excludes one note with the P07 that reminds you of this.
And also, in the instructional note, under the P07 category, it reminds the coder that
when both birth weight and gestational age are available, we’re going to choose two
codes from P07.
The code for the birthweight will be sequenced before the code for the gestational age.
In this example, the baby was born small for dates, and what that means is it was full
term, but it weighed less than the doctor thought it would weigh, given it full term.
And the doctor tells us that her weight at birth was 1770 grams, and the doctor the baby
has problems because of her mother’s use of chemo before the mother knew she was pregnant.
So, we have the rationale and the pathway here on the right, we’re going to small-for-dates,
and using the range of weights that’s given, P05.17, and the newborn affected by the maternal
use of medication.
There was no sub term for chemo therapy, so I chose the medication sub term as the closest
thing.
In this example, we’re looking at the P07 category, learn both the birth weight and
the gestational age were given to us, and following our coding guideline birthweight,
code goes first, than the gestational age, and in this case, the P07 category code is
used for a child that was premature at birth, and her prematurity has affected her development.
So, we’re going to put your P07 codes, and then do your development with the leg codes
for the motor coordination and the speech.
In this example, the Z38 code is your principle diagnosis because we’re coding the birth
episode.
And following that birth episode code, we are now going to code the hemolytic disease
due to the ABO isoimmunization.
There are the pathways on the right.
In this example, we are given the birthweight, as well as the gestational age, and this particular
baby, very low birthweight, and following our rationale and our pathway on the right,
you see where the preterm takes you to gestational age at 33 completed weeks.
P07.
And then we have the hyaline membrane disease.
I put the coding guidelines on the left, just because there’s a little bit more room there.
In this example, we have extreme immaturity.
If you can remember a premature baby, and extreme prematurity called immaturity, this
is when you are less than 28 completed weeks.
Very few infants when they’re so small and so poorly developed.
And I use the P96.1 code to indicate the baby was in withdrawal, because of the mother’s
addiction to heroine.
Example 6, we have the infant with the hemolytic disease, and I make the notation that the
patient was received by transfer from another facility.
And a part of the guideline that applies in this case is that the Z38 code is only assigned
once, and it’s assigned at the hospital where the birth occurs.
So, because the case that’s given to us here in the diagnostic statement, the patient
was received by transfer, and we will not be using the C38 code here.
Here’s example 7.
And I have pathway on the right.
We are using the principle diagnosis of Z38.01.
The baby was born in this hospital by cesarean.
And then I have the problems that are occurring, prenatal conditions that are occurring, that
are coded there.
The next example is kind of long, but I wanted to just step us through it.
It is a term birth, meaning it’s not a premature baby, but the baby is born with sepsis.
Severe sepsis.
Codebook does make a distinction between sepsis, and severe sepsis.
So, when those words are used, severe sepsis, you’re going to be looking at an R code.
And in this case, I gave you a little cheat note that amnionitis may also be documented
as chorioamnionitis, because in the alphabetical index, you need to know that.
The Z38.00 code is our principle because the baby was born in this hospital.
Hemic code, the sepsis code, and in this case, there is a combination code for the newborn
sepsis and the ecoli.
And instructional note with that category code.
Telling us that we – if we have severe sepsis identified, we need to use that R65.20 code.
And then we have the chorioamnionitis, and to help us in our sequencing, there’s an
instructional note that says code first in the current condition, in the newborn, in
the new case with this newborn.
The baby has the sepsis, and that comes in front of the chorioamnionitis code.
And last of all, the sepsis code.
The next example is just a reminder to us that some hospitals do keep records for stillbirths,
and if you’re working in one of those hospitals, you’re going to simply find the main term
stillbirth, P95, and that is the only code you’re going to have on that record.
It is not used on the mother’s record only, on the baby’s record.
It is the only code that is on the baby’s record.
Now, for a couple reminders for chapter 17.
We’re only going to assign Chapter 17 codes when there is documented evidence that the
congenital malformation, deformation, or chromosomal abnormality.
Chapter 17 codes can be principle or secondary, depending upon the circumstances of the admission.
If you have a doctor documenting a malformation that does not have a code, then you are going
to assign any code you need to – to catch that manifestation.
Typically, though, I find that there are codes for the things that we see the most often.
In the code assignment that identifies a malformation, a deformation, or abnormality, the manifestations
are inherent as part of that, and if they were not, then you would be assigning those.
As in chapter 16, chapter 17 can be used throughout the life of the patient, but if a malformation
or deformation is corrected, then you’re going to find a personal history code or Z
code that shows that patient had that malformation or deformation and it was corrected.
And there are times when those are not diagnosed until later in life.
So, chapter 17 codes can be used at any point in a patient’s life.
If you noticed in the guidelines, too, in the front of Chapter 17, they’re not numbered
the same way as some of the other guidelines because they’re just very general.
A couple that I’ve chosen to highlight and one is the tetralogy of Fallot, and I have
here it’s pronounced either “fah –low” or “Fal- low”, depending on how your doctor,
your hospital pronounces it.
The main thing is that that T, that ending T is not pronounced.
And pulmonary stenosis is inherent in this disorder.
I’m going to show you – I did find a couple of things on these heart conditions.
This is on the American Heart Association’s website.
It talks about the tetralogy of Fallot, and it’s actually a heart defect that has four
problems.
And it shows us here, by bullet points, and by our picture, exactly what it means for
a baby to be born with this.
It is very rare, but it does happen.
I think it’s one in 20,000 births a baby can have tetralogy of Fallot, also you can
see it abbreviated as T of F on the baby’s chart.
So, here’s an eight day old infant with tetralogy of Fallot and pulmonary stenosis.
It’s a very simple, main term, tetralogy.
Q21.3 is the code.
And here we have a seven month old with Down syndrome, and AV canal defect.
But the diagnostic statement says common atrioventricular canal – and that is – what that means
is its common, meaning that some of the divisions that are normally in the heart are not there,
so the atrium and the ventricle, for example, can be sharing the space, so now it’s common
space.
So, what you’re really coding for a common AV canal is a defect.
And I have the pathway here on the right.
What is seen in patients with down-syndrome is not considered a manifestation of Down
syndrome, therefore, it would be coded separately.
As I mentioned earlier, a code from chapter 17 can be used throughout the life of the
patient, and if something has been corrected, we do want to have a history code, and the
example that I’ve taken here from your codebook is three year old with a history of corrected
ventricular septal defect.
And you find in the history codes, as a congenital malformation of the circulatory system, and
I’m showing you, you could also have looked up a corrective heart problem.
Either way, you get the same code, and you only use that code once as a general coding
guideline.
As with many of our chapters, the exercises in this PowerPoint do not address all of the
guidelines.
Exam questions can related to all the guidelines covered in the chapters planned for each week.
Always follow your assignment schedules with regards to specific chapter assignments.
If you have any specific questions, please post them in the discussion board.
Thank you so much, and have a good week.