Monday, December 19, 2011

Ob-Gyn Coding: Deliver Postpartum V Codes With Care by Suzanne Leder

Bonus: Get exposure to ICD-10 coding equivalents

Question: A mentally-retarded patient who delivered at home was admitted to the hospital for postpartum care. She delivered the placenta at home, and once she was admitted, there were no complications. However the ob-gyn did perform a first degree laceration repair. I am not sure what diagnosis code to go for. Should I take a look at routine postpartum care or pregnancy complications? And in case I use a complication code, what would the fifth digit to a “1” or “0?”

Answer: Under most situations where the ob-gyn treated no problems during the admission, you would have to go for code V24.0 (Postpartum care and examination; immediately after delivery) on the admission date and V24.2 ( Routine postpartum follow-up) for any subsequent routine care.

However in this case, your physician also repaired a first degree laceration (CPT code for 59300, Episiotomy or vaginal repair, by other than attending physician). As such, you may consider this to be an admission for a postpartum condition and instead go for 664.04 (First degree perineal laceration). The fifth digit can’t be “1” or “0” as the patient delivered before her admission and of course you know her delivery status. The fifth digit must be “4” in this case to indicate a purely postpartum condition. Optionally you may report V24.0 and V24.2 as your secondary diagnoses, however they’re not required in this case.

ICD-10: In the immediate future, you will replace ICD-9 codes V24.0 and V24.2 with ICD-10 codes Z39.0 (Encounter for care and examination of mother immediately after delivery) and Z39.2 (Encounter for routine postpartum follow-up), respectively. Code O70.0 (First degree perineal laceration during delivery) will replace 664.04.