2nd opinion for coding scenerio


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I was looking for a 2nd opinion on a coding scenerio that I have never had arise.

The patient was admitted for a D&C due to a fetal demise and subsequently started hemorrhaging and have to have a TAH. Would you code this the same way that I have chosen?

59821 D&C 632
58150-78 TAH 634.71, 998.9, 459.0

other possible ICD-9 codes

Without the op reports it is hard to say for sure. Based on what you wrote, I agree with your procedural coding but came to a different conclusion with the diagnoses. For the hysterectomy, the primary reason it was done was not the miscarriage, it was the complication afterwards. Code 998.9 states it excludes obstetrical surgeries and although the pregnancy was lost, I would consider a D&C for missed AB to be an obstetrical surgery. Therefore, I would choose code 669.40 as the primary code and 626.9 uterine hemorrhage as the secondary code. I don't think I would append a miscarriage code since that diagnosis was treated with the first procedure but if you think it should be there, I would use the 632 since that was the code from the D&C. Good luck!