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OB ICD-9 Coding

Created: 12/11/13 | Updated: 2/26/15
Question:  Is it appropriate to ever put a “fetal problem” dx on a mother’s charge?  For example, the mother is the patient but the baby has a problem. Where do I put the baby’s diagnosis?

Answer: With documentation to support, codes from categories 655 and 656 can be appropriate. Codes from categories 655, Known or suspected fetal abnormality affecting management of the mother, and 656, Other known or suspected fetal and placental problems affecting the management of the mother, are assigned only when the fetal condition is actually responsible for modifying the management of the mother, i.e., by requiring diagnostic studies, additional observation, special care, or termination of pregnancy. The fact that the fetal condition exists does not justify assigning a code from this series to the mother’s record.

In cases when surgery is performed on the fetus, a diagnosis code from category 655, known or suspected fetal abnormalities affecting management of the mother, should be assigned identifying the fetal condition.

No code from Chapter 15, the perinatal codes, should be used on the mother’s record to identify fetal conditions.

The 678 & 679 series have also been deemed appropriate to use for fetal surgeries when documentation supports.

Question:  When coding anesthesia for a delivery, do I use “antepartum” 5th digit, or “delivered” 5th digit?  For example, the mother was pregnant at the beginning of the C-section, they administered anesthesia and did a C/S. Do I use “3” or “1” for the 5th digit on the anesthesia charge?

Answer:  When a delivery occurs, the principal diagnosis should correspond to the main circumstances or complication of the delivery. In cases of cesarean delivery, the selection of the principal diagnosis should be the condition established after study that was responsible for the patient’s admission.

The fifth-digits, which are appropriate for each code number, are listed in brackets under each code. The fifth-digits on each code should all be consistent with each other. That is, should a delivery occur all of the fifth-digits should indicate the delivery.

In the scenario above, if the delivery occurs, you should use “1” for the 5th digit.