Ob-Gyn Coding Alert

Question: My ob-gyn admitted a 30-year-old primigravida for elective induction with a ventral hernia. The patient complained of nausea and stopped breathing. She has a history of hypertension, type 2 diabetes, and gastric bypass. The ob-gyn found a placental abruption and the patient was rushed for an emergency c-section. He did not perform the c-section, just the antepartum care. After the c-section, the patient had significant vaginal bleeding and was hypotensive. The ob-gyn took her back to the OR the same day, where he did a lap/TAH. Should I report diagnoses 666.xx, 669.44, V45.3, V81.0, and V17.4? Can I use modifier -78 or -22?


Alabama Subscriber


Answer: First, let's address the modifier question. Since you're not reporting the cesarean, you would not require modifier -78 (Return to the operating room for a related procedure during the postoperative period).
 
If you wanted to use modifier -22 (Unusual procedural services), you would have to have surgical documentation showing significant additional work above and beyond a TAH (58150-58152). Remember, a TAH includes the exploratory portion.

For the diagnosis codes, report 666.12 (Other immediate postpartum hemorrhage; delivered, with  mention of postpartum complication) or 666.22 (Delayed and secondary postpartum hemorrhage; delivered, with mention of postpartum complication).

She was hypotensive, so you should go for 669.21 (Maternal hypotension syndrome; delivered, with or without mention of antepartum condition) and not 669.44 (Other complications of obstetrical surgery and procedures; postpartum condition or complication).

Remember, you can't use the second "4" because the patient is still in the hospital and delivered during this hospitalization. You would only use a fifth digit of "4" if she still has postoperative complications after her discharge.

Using V45.3 (Intestinal bypass or anastomosis status) is OK because this code helps to establish risk, but why report V81.0 (Special screening for cardiovascular, respiratory, and genitourinary diseases; ischemic heart disease) and V17.4 (Family history of certain chronic disabling diseases; other cardiovascular diseases)?These two V codes are not supporting reasons for performing the TAH.