745.5 vs. 747.0-When to use?


True Blue
Overland Park, Kansas
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My question is in regards to PDA/PFO on newborn records. My research indicates that all newborn patients have physiologic coronary anatomy that includes PDA/PFO. Newborns, due to the transition from life in the woumb to extrauterine life, develop a coronary anatomy that sustains the fetus and then transitions to normal coronary anatomy shortly after birth. Recently I have noticed hospital coders listing diagnoses codes 747.0, Patent ductus arteriosis and 745.5, Ostium secundum type atrial septal defect on almost every newborn record. The listing of these "physiologic" (normal) conditions has a huge impact on reimbursement/DRG assignment in newborn cases. In some cases Pediatric Cardiologist examine infants and describe their findings as "normal physiologic PDA/PFO" or "Closing PDA/PFO." Usually they have been asked to evaluate the infant due to another health care provider hearing a murmur. Logically, if a Pediatric Cardiologist examines the anatomy of the neonatal heart and finds it to be "normal" or "physiologic neonatal cardiac anatomy" and recommends no further treatment and "follow up in six months" to be sure that no murmur still exists, then a diagnosis code of 745.5 or 747.0 would not be warranted. Rather, code 785.2 Murmur, would be more appropriate since this is the condition being evaluated by the Pediatric Cardiologist. Can you provide some clarification of when it would be appropriate to list diagnoses codes 745.5 and 747.0 on newborn records? Thank you,