Wiki Nuchal cord in delivery

[BrendaAS]

When a delivery summary states "nuchal cord x1, loose, slipped over head" does that require the O69.81X0 Labor and delivery complicated by cord around neck, without compression, not applicable or unspecified?

I'm in Vermont and Medicaid is denying claims stating the O69 code cannot be primary but the only other codes are Z370 and Z3A37. Should I be using O80 and leave the O69 off because the cord did not actually create a "problem"?

 

[ahguzman]

ICD 10 guidelines state the provider must the condition is not a complication. I would not use Z37.0 as a primary diagnosis (even if you're billing professional and not facility). The patient delivered at 37 weeks? Why the early delivery; what was the reason for admission?

 

[fwnewbie]

All there saying is 069 can't be primary. Code first the live birth and add the 069 as secondary. At least that's what I would do.

 

[fwnewbie]

I believe 37 weeks is considered term.

 

[vronica]

Hi, here is a link to diagnosis codes that are not accepted as primary by Vermont Medicaid: https://dvha.vermont.gov/for-provid...ted-codes?portal_status_message=Changes saved. I searched and diagnosis code O69.81x0 is listed on there as not accepted. If the patient showed up in active labor at 37 weeks and has no other complications, then I would bill O80, Z37.0 and Z3a.37, since they are not allowing the unspecified code as primary.

 

[fwnewbie]

I remember reading somewhere that coding should tell a story of the patient encounter and I love that!

 

[Cmama12]

These Medicaid providers are really a PIA. Per ICD 10 guidelines for chapter 15, you would code first the reason for admission; therefore it would be inappropriate to have an outcome of pregnancy code or weeks of pregnancy code as primary. Also, although 37 weeks is considered full term per ICD 10, there is now a classification of "early term" for 37 and 38 weeks - therefore Anthem Medicaid, for example, has a ridiculous list of "acceptable" diagnosis that would "justify" a delivery before 39 weeks. Nevermind that many are spontaneous deliveries. If the H+P actually states an acceptable diagnosis, but the delivery note itself does not, I would go back to the provider to have them addend their note. Eg, patient was actually induced because of hypertension or something.