Assign a code from category 648 for patients who have a current condition affecting pregnancy. Coding and sequencing are dependent on the physician documentation in the medical record and application of the Official Coding Guidelines for inpatient care. To assign code 650, Normal delivery, the patient must meet these requirements: a full-term pregnancy; a single, liveborn infant; no unresolved antepartum, during the delivery, or postpartum complications; no instrument-assisted delivery except episiotomy 73. If a patient is admitted for a complication of pregnancy and during the hospital stay, a C-section is performed for other reasons, the principal diagnosis will be the condition that necessitated the admission, not the reason for the C-section. More information about 3M Health Information Systems is available at www.
A type 1 Excludes note is a pure excludes. For example, if a patient is admitted nine weeks postpartum with cardiomyopathy and the physician documents postpartum cardiomyopathy, code 674. Also, chapter 11 codes are only assigned on the pregnancy record and should never be assigned on the newborn record. . The company and its representatives do not assume any responsibility for reimbursement decisions or claims denials made by providers or payers as the result of the misuse of this coding information. If a patient is admitted for labor induction without an indication or a reason and no complications occur during the delivery, code 650 may be assigned as the principal diagnosis.
The list of Inclusion Terms is useful for determining the correct code in some cases, but the list is not necessarily exhaustive. A 'billable code' is detailed enough to be used to specify a medical diagnosis. Selection of the principal diagnosis depends on the main reason or complication of the encounter. Certain conditions have both an underlying etiology and multiple body system manifestations due to the underlying etiology. Sinoatrial bradycardia Sinus bradycardia Slow heart beat Vagal bradycardia Additional Code Note: Use Additional Code Use Additional Code note means a second code must be used in conjunction with this code.
These instructional notes indicate the proper sequencing order of the codes, etiology followed by manifestation. Although the pregnancy-related code must be sequenced first, additional codes from other chapters may be assigned as secondary diagnoses to completely classify the condition. Diabetes mellitus in pregnancy is classified to code 648. April 13, 2009 Review of Pregnancy Coding Guidelines For The Record Vol. Billable Code Billable codes are sufficient justification for admission to an acute care hospital when used a principal diagnosis.
If there is more than one pregnancy complication and all are treated, evaluated, or monitored, then any of the pregnancy complication codes may be sequenced first. If a patient is admitted but does not deliver during this episode of care, the principal diagnosis will depend on the circumstances of admission. List of terms is included under some codes. When symptomatic, it may cause fatigue, weakness, dizziness, and at very low rates fainting. An Excludes1 is used when two conditions cannot occur together, such as a congenital form versus an acquired form of the same condition.
A type 2 Excludes note represents 'Not included here'. If the patient does deliver during this episode of care, then the main circumstance should be sequenced first. When an Excludes2 note appears under a code it is acceptable to use both the code and the excluded code together. Additional terms found only in the may also be assigned to a code. If the physician documents that the patient has a postpartum condition, even after the six-week time frame, the condition should be coded as postpartum. If the patient undergoes a Caesarean section, then the reason necessitating the C-section should be sequenced as the principal diagnosis. These terms are the conditions for which that code is to be used.
Codes with this note are Etiology codes and must be followed by a Manifestation code or codes. The inclusion terms are not necessarily exhaustive. An Excludes2 note indicates that the condition excluded is not part of the condition it is excluded from but a patient may have both conditions at the same time. If a patient is admitted within six weeks after delivery, assign the postpartum complication code as the principal diagnosis. .
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