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Medical Coding II

Medical Coding II. Seminar 6. Unit 6 Overview. Reading, Understanding ICD-9-CM Coding: Chapters 16, 19, 20 Graded Assignments Seminar, Attend Seminar or Complete Option 2, 20 Points Exercises, Challenge exercises derived from your textbook, 20 points Quiz, 60 points.

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Medical Coding II

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  1. Medical Coding II Seminar 6

  2. Unit 6 Overview • Reading, Understanding ICD-9-CM Coding: Chapters 16, 19, 20 • Graded Assignments • Seminar, Attend Seminar or Complete Option 2, 20 Points • Exercises, Challenge exercises derived from your textbook, 20 points • Quiz, 60 points

  3. Mom’s Codes versus Baby’s Codes • Health record for mother • Chapter 11 codes (630–677) are used to describe the maternal conditions and reported only on mother’s record • V27 category for outcome of delivery • Health record for baby • V30 category for newborn status • Codes 760–763 and 764–779 identify conditions of newborn

  4. Coding the Mom’s Record

  5. Index Entries • Pregnancy • Labor • Delivery • Puerperium, puerperal, or postpartum • Many indentations under each term • Requires close attention to index entries

  6. Terms of Pregnancy • Preterm: Delivery before 37 completed weeks of gestation • Term: Delivery between 38 and 40 completed weeks • Postterm: Delivery after 40 completed weeks through 42 completed weeks • Prolonged: Delivery after 42 completed weeks

  7. Classification of Pregnancy • 633, Ectopic pregnancy • 640–649, Complications mainly related to pregnancy • 650–659, Normal delivery and other indications for care • 660–669, Complications: labor and delivery • 670–677, Complications of the puerperium • 678–679, Other maternal and fetal complications

  8. Pregnant Patient • Obstetrical patients require a code from 630–679 from chapter 11 of ICD-9-CM • If patient’s treatment is not affecting the pregnancy, assign code V22.2, rather than a code from chapter 11 • Physician is responsible for documenting that a condition is not affecting the pregnancy

  9. Sequencing of Codes • Principal diagnosis selection • Circumstances of the encounter or admission determine the principal diagnosis • If no delivery, principal diagnosis should identify the principal complication that necessitated the admission

  10. Sequencing of Codes (continued) • Principal diagnosis selection • When delivery occurs, principal diagnosis should identify the main circumstance or complication of the delivery • If a cesarean delivery was performed, principal diagnosis should reflect the reason for the admission

  11. Sequencing of Codes (continued) • Principal diagnosis selection • Routine prenatal visits without the presence of any complication • V22.0, Supervision of normal first pregnancy • V22.1, Supervision of other normal pregnancy • V22.0 or V22.1 are not used with additional codes from chapter 11

  12. Sequencing of Codes (continued) • Principal diagnosis selection • Prenatal visits in high-risk pregnancy • Code from category V23, supervision of high-risk pregnancy, should be sequenced first • Additional codes from chapter 11 should be assigned to describe specific complication

  13. Fifth-Digit Subclassification • Assignment of fifth digit describes the episode of care • Fifth digits required • 640–649 • 651–659 • 660–669 • 670–676 • 678–679

  14. Fifth-Digit Subclassification (continued) • 0 – unspecified as to episode of care or not applicable • 1 – delivered, with or without mention of antepartum condition • 2 – delivered, with mention of postpartum complication (complication developed after delivery but before woman was discharged from hospital)

  15. Fifth-Digit Subclassification (continued) • 3 – antepartum condition or complication • may be described as “undelivered” • 4 – postpartum condition or complication • woman delivered during earlier episode of care

  16. Fifth-Digit Subclassification (continued) • Fifth digit of 0 should not be used if at all possible, find out more about the patient • When delivery has occurred during current episode of care, fifth digit is either 1 or 2 • Fifth digit of 1: Patient delivered, may or may not have had an antepartum condition • Fifth digit of 2: Patient delivered and developed a complication after delivery but before discharge

  17. Fifth-Digit Subclassification (continued) • Fifth digit of 3 • Delivery has not occurred during this episode of care • Patient remains pregnant; undelivered • Fifth digit of 4 • Delivery has occurred during a previous episode of care • Patient care is occurring less than 42 days after delivery and a postpartum condition exists

  18. Fifth-Digit Subclassification (continued) • Fifth digits of 1 and 2 can be used on different codes for the same episode of care as both indicate a delivery has occurred but complication developed at different times • Fifth digit of 3 can only be used with other codes with fifth digit of 3 • Fifth digit of 4 can only be used with other codes with fifth digit of 4

  19. Obstetrical Procedures • Volume 3 • Main term is delivery or other procedure title • Category 72, Forceps, vacuum, and breech delivery • Category 73, Other procedures inducing or assisting delivery • Category 74, Cesarean section and removal of fetus • Category 75, Other obstetric operations

  20. Coding the Baby’s Record

  21. Newborn Coding Guidelines • Newborn period is defined as beginning before birth and lasting through the first 28 days after birth • All clinically significant conditions noted on routine newborn examinations should be coded • Physician documentation indicates whether a condition is clinically significant

  22. Newborns, Congenital Anomalies and Perinatal Conditions • Newborns may have congenital anomalies (740–759 ) and certain other conditions that originate in the perinatal period (760–779) • Coding the birth of an infant • First code is from categories V30–V39 • Additional code from 740–759 and/or 760–779 assigned for additional conditions

  23. Newborn Coding Guidelines (continued) • A newborn condition is significant if it requires: • Clinical evaluation • Therapeutic treatment • Diagnostic procedures • Extended length of hospital stay • Increased nursing care and/or monitoring • If it has implications for future healthcare needs

  24. Newborn Coding Guidelines (continued) • Codes should be assigned for conditions that have been specified by the provider as having implications for future health care needs • Codes from the perinatal chapter should not be assigned unless the provider has established a definitive diagnosis

  25. Principal versus Additional Diagnosis • Hospital stay at time of birth • Principal diagnosis in V30–V39 section • Additional diagnosis for congenital anomaly or other condition such as prematurity • Infant transferred to second hospital • Follow definition of principal diagnosis • Generally the reason for transfer, such as anomaly, perinatal condition, or complication • V30–V39 is not used again

  26. Questions?

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