Okay let's look at another one. This is Exercise 24.4 #9
and this is a pregnancy complicated by
abruptio placentae. I looked that up. That is a premature separation of the
placenta, either partially or totally, from the uterus. Separation of the
placenta from the uterus causing 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 placenta is
how the baby gets oxygen and also nutrients are deprived and then the
maternal (morbidity and mortality) because of the severe bleeding. It can be morbidity and mortality for
her. There's uterine contractions, there's fetal distress and the bleeding
of course. Okay so here we've got a term pregnancy, so it's not preterm. Delivered
a single stillborn, left occipital anterior, terminal abruptio placentae and
a cord wrapped tightly around the neck with compression. The documentation does not call this
cord with compression a nuchal cord but I have seen that in medical
records. It means the same thing. I am not clear what the left occipital anterior
refers to in this case but based upon the codes that were in the answer key
that I had, 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 abruptio 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 infant, stillborn and that weeks of gestation, 39.
The first code is the pregnancy complicated by the abruptio placentae
and you see that it takes you completely out of the pregnancy codes, which I find
so interesting. I am not sure why that is because when you go to the abruptio
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. We're looking at the Tabular. We see that we need a 5th character to
assign the trimester. In this case, it's the third trimester. So our final code
O45.93. Now let's look at the second part, the delivery
complicated by the cord around the baby's neck and it's pretty straightforward.
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 get
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 "0" as our seventh character and that takes care of
our second bullet point. When we go 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 the pregnancy weeks of
gestation. I had this slide just to remind all of us, especially me, it's all
in the numbers. It's so important in the pregnancy chapter to know the
numbers. So wherever you need to write this down, I write it on the page
opposite my guidelines. I'll show you in just a second. I write definitions, just
things I need to remember. Preterm labor is any labor before 37 completed
weeks, Post term pregnancy is over 40 completed weeks to 42 completed weeks, that's a
post-term but when you get beyond 42 completed weeks, now you're
talking about a prolonged pregnancy. 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 I'm in my code book. I want to show you where I have things written. This is
Chapter 15 in the code book and just opposite, 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 preterm 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've got 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 the delivery, the weeks of
gestation and any procedures that are done. So this is just a reminder to me to
be sure I've coded enough whenever I'm coding a delivery chart. Okay let's look
at a couple of examples that are not in the Coding Handbook. This is a spontaneous abortion
of a single fetus at 21 weeks, complete. That means a "complete" abortion. You
have spontaneous abortion, you can have a complete spontaneous abortion meaning all the products of
conception are expelled or you can have an "incomplete" abortion where the body has
retained some of the products of conception and you often have to have a
D&C procedure. Spontaneous abortion is really preterm labor with preterm delivery so
that helps you know how you're going to code it. 21 weeks is a second trimester
and if the gestational age is beyond 20 weeks, you're going to look up
"delivery" as the main term instead of "abortion".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 of 21 weeks would be stillborn so that's how
you get that Z37.1 code so
here we've got okay so here is
the pathway for the preterm labor with delivery, the weeks of gestation, and the
outcome of delivery.
I just make a little note here about Clinical Coding Workout. That's
where I got this particular exercise. If any of you plan on becoming
coders, I recommend that you get your hands on the Clinical Coding Workout or
something that gives you more scenarios than we can do in this class . They will 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, using things like that to find
codes. Okay, here's another one and this one was 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 1 note with this O03.31 code which
tells you you can't use both of those together so my conclusion is because the
shock is due to a 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 the patient has septic
shock and septic shock is classified to R65.21 and that would be your
secondary code.
As always be mindful the exercises in this PowerPoint don't address all of the
guidelines for 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.
you