Oh right, medical coding for pregnancy.
I really like this because this is one of the most common questions that I get when
Iím teaching.
Pregnancy can be really intimidating because thereís so many codes that are involved.
One of our PBC students had stated, ìHow many codes do I need when I code a pregnancy
and delivery?
This continues to confuse me.
I think I have all of them and when I check my answer, Iíve missed one.î And if you
click on that answer, Iíve got a scenario thatís actually in the Carol Buck book that
covers several.
When youíre dealing with pregnancy coding, the first thing you need to determine, ìthe
motherís chart or the babyís chart?î.
Now, with pregnancy coding, you would be thinking, ìOkay well, pregnancy isnít the baby.î
But as long as the mother is pregnant and has not delivered, everything that happens
to the fetus or the mother is put on the motherís chart.
Then once the baby is delivered, you have a newborn chart and things get separated.
That can confuse people sometimes, as well, so make sure youíre in the proper chart.
Some of the key terms that you want to look for when you go to code pregnancy: gestation,
cesarean delivery, vaginal delivery and if it was a viable or a living infant.
Youíll see both those terms.
Okay, this is one from the textbook that we use, the Carol Buck books that we like so
well, the Step by Step.
Mrs. Smith is a 32-week gestationÖ and I highlighted all the terms that youíre going
to pull out of thisÖ and is admitted with a severe bleeding and abdominal cramping.
An emergency ultrasound is done and fetal monitors are applied.
Sheís diagnosed with total placenta previa with indications of fetal distress.
An emergency cesarean section is done with delivery of a viable, male infant.
So I broke down the codes that you would use for this.
This is actually in the ICD-9 section of our book but I went ahead and pulled out a CPT
code.
And when youíre doing CPT codes for delivery, itís a cesarean delivery only.
Youíll also find codes for CPT where your patient tried to deliver vaginally and was
not able to and so then they reverted to a cesarean delivery or they went in as cesarean
initially.
Those are things you want to pay attention to.
So your ICD-9 codes, weíll just start at the very beginning.
So we have a pregnant patient and itís complicated because thereís a problem.
Whenever you see any type of a problem then thatís a red flag.
And the term youíre going to look up is complication or complicated.
What did she have that was complicated?
She had a problem with her placenta.
What was it?
It was placenta previa.
So that code, 641.11 is the code that weíre going to use first.
Thatís why she was brought in because she had a complication with the pregnancy.
The bleeding, all of that, or the signs and symptoms of the placenta previa, so you donít
code those.
Now what did this result in?
We have distress of the fetus so you look up distress.
Of what?
The fetus and itís affecting the management of the pregnancy.
How is it affecting the management of the pregnancy is that weíre going to have to
deliver.
Placenta previa is a danger to both the baby and the mama.
Youíll bleed out and youíll bleed out very quickly so that could result in death of both
the mother and the baby.
Itís something that they have to take care of quickly.
So it affected the management of the pregnancy.
Thatís whatís going to be coded next.
You notice as weíre going along, weíre painting a picture and weíre justÖ weíre giving
a description of each step of whatís going on with the mama.
So next, what happened?
We had the pregnancy.
It was complicated and itís early onset of delivery.
We noticed our mama was 32 weeks.
Forty weeks is full gestation.
So anything befor 40 weeks is going to be early onset delivery which tells the insurance
company, ìOkay, we have a possible preemie here and so heads up on other complications
that can come with that.î
Now our last thing that happens is we have a viable male infant.
It doesnít matter if itís male or female.
Thatís not a coding thing that you need to worry about.
But knowing how many is delivered and stuff is important.
This is the V code.
All pregnancies with deliveries end up with a V code.
Donít leave those off so when youíre taking your CPC exam, you may see all of these codes
on there.
You think, ìOkay, Iíve got it but they left the V code off.î And so thatís a heads up.
Donít leave the V code off.
What do you have?
The outcome is the term you look up.
Outcome of delivery, single and then liveborn because you have stillborn babies and thatís
a separate code.
So everything turned out fine.
We have the outcome.
We had one baby that was born and the baby was born live.
Thatís where you get the viable.
And thatís how you do a pregnancy code when you have complications.
You just go from the beginning to the end, step by step, kind of in order as they happen
and make sure that you get everything thatís listed.
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