Ch.24 and 25 Part 2.Pregnancy, Childbirth, Puerperium;Abortion, Ectopic Pregnancy


ok let’s look at another one this is exercised 24.4 number nine and this is a pregnancy complicated by abruptio placenta and I looked that up that is a premature separation of the placenta either partially or totally from the uterus separating 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 where how the baby gets oxygen and also nutrients are deprived in the maternal because of severe bleeding it can be morbidity and mortality for her there’s utero contractions there’s fetal distress and the bleeding of course ok so here we’ve got a term pregnancy so it’s not preterm, delivered a single stillborn left occipital interior terminal abruptio placentae and a cord wrapped tightly around the neck with compression it 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 occipito 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 placenta, 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 child, single infant was stillborn and weeks gestation 39.The first code is the pregnancy complicated by the abruptio placentae you see that it takes you completely out of the pregnancy codes which i find so interesting 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 it does and we look at the tabular we see that we need a fifth character to assign the trimester in this case is the third trimester so our final code both for 5.93 now let’s look at the second part the delivery complicated by the corner on 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 got another one’s pink boxes telling you your 7th character in this case the 7th character is telling us which Vegas we have a single fetus so we’re going to choose 0 as our 7th character that takes care of our second bullet point we go here we have to also code maternal care for intrauterine death the academic 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 delivery single stillborn and the pregnancy weeks gestation ok let’s look at this one and elderly prima gravity’ 37 years old 40 weeks gestation spontaneous delivery living female infant you notice this time I didn’t say live one it says living so sometimes your words a little bit different but you know what they mean you’re going to code supervision believe it or not a woman who is 37 years old was considered a high-risk pregnancy so that is why we fall into a special code here the outcome delivery in the recent gestation or here and if you’re wondering about the definition of prima gravity’ let’s look at that if you can’t remember the definition of elderly primack gravity’ it’s right here in the codebook 35 and older at delivery so you’re six characters going to be your trimester from gravity is first pregnancy multi gravity’ other than first like 2nd 3rd 4th whatever but the age being 35 years and older I have this slide just to remind all of us especially me it’s on the numbers is so important in the pregnancy chapter IV 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 right definitions just things i need to remember preterm labor a labor before 37 weeks comes to get 37 complete weeks post term pregnancy is over 40 completed weeks 242 that’s a post term but when you get beyond 42 now you’re talking about a prolonged pregnancy and 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 in my code book i want to show you where I have things written this is chapter 15 codebook and just opposite at the is actually the end of the guidelines for chapter 15 there’s a little bit of room there so i have written myself knows like here get this up 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 is going to be normal or whatever complication there is the album delivery the weeks gestation and any procedures that are done this is just a reminder to me to ensure i coated enough whatever i’m coding a delivered chart ok let’s look at a couple that are not in the coding handbook this is a spontaneous abortion of a single fetus at 21 weeks complete complete meaning a complete abortion you have spontaneous abortion you can have a complete meaning all the price of conception were expelled or you can have an incomplete where the body is retained some of the price of conception and you also have to have a DNC spontaneous abortion is really preterm labor with preterm delivery so that helps you know how you’re going to coat it 21 weeks is a second trimester and if you’re just a Chanel age is beyond 20 weeks you’re going to look up delivery instead of abortion and the outcome delivery we have to code it but you notice it didn’t tell us live or not but obviously at 21 weeks a fetus can survive so if he was at 21 weeks would be stillborn so that’s how you get that CD 37.1 code so here we’ve got ok so here is the pathway for the preterm labor with delivery two weeks gestation and the outcome I just make a little note here about clinical coding workout 2016 that’s where I’ve got this particular exercise from if any of you plan on becoming coders i recommend that you get your hands on a clinical coding workout or something that gives you more scenarios that we can do in this class to 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 or using things like that to find codes here’s another one and this one is a little tricky 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 incomplete abortion was shocked but then when you go and you look up your codes there’s an excludes one note with this 0 3.31 code which tells you you can’t use both of those together so my conclusion is because the shock is due to sepsis I would assign the substance code which is the first one here it also tells us to code infectious agent what caused the steps as if we know it we are given that but we are told the patient is septic shock and septic shock is classified to our 65.2 one 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 and I working my best to answer them thank you so much

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