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unrelated pregnancy admit?

  1. #1
    Default unrelated pregnancy admit?
    Medical Coding Books
    patient is s/p delivery 5 days prior to getting admitted for "Chest Pain" no where in the chart does the MD related the Chest Pain to her recent pregnancy/delivery.

    Would I use 786.59 or 648.94?? Thanks!!

  2. Default
    I do know that if the patient is pregnant, you have to state it is not related. However, I "think" that if the patient is postpartum you still have to state it is not related. I am sure somebody will either confirm this or state that I am totally wrong, but something is nagging me telling me it is the same for postpartum..... I sure hope I didn't confuse you

  3. #3
    If they don't mention pregnancy related and she is not pregnant I see no reason to even consider the pregnancy/postpartum codes. I am assuming it is not the OB/Gyn that admitted her for chest pain though.

    If you are really in doubt question the provider. You can't use a code that is not stated, which the pregnancy/postpartum one is not.

    Just my opinion,

    Laura, CPC, CPMA, CEMC

  4. #4
    That's exactly what I was thinking...thanks

  5. #5
    I was under the impression that postpartum/pregnancy was overarching when it came to diagnoses. Postpartum should be up until about 6 weeks post delivery so anything happening in that time frame would still be coded with the pregnancy/postpartum codes as complications. That is according to Faye Brown and Coding Clinic. Here are the sources:

    COPD with acute exacerbation occuring post-partum
    ******Coding Clinic, First Quarter 2009 Page: 17 Effective with discharges: March 27, 2009 Question:

    The patient is 37-year-old woman who was admitted five-weeks post-partum for treatment of an acute exacerbation of chronic obstructive pulmonary disease (COPD)/asthma. The patient had an uncomplicated pregnancy and delivery. She has anemia and hypertension and a past history of tobacco abuse. The obstetric coding guidelines seem to imply that any condition occurring during pregnancy, childbirth, or the puerperium is considered to be a complication unless the attending physician specifically documents that it not. Since the COPD is a pre-existing condition, would a chapter 11 obstetric code be assigned? How should this case be coded?


    Assign code 648.94, Other current conditions classifiable elsewhere, postpartum condition or complication, to identify that the patient’s condition occurred during the postpartum period. The postpartum period begins immediately after delivery and continues for 6 weeks following delivery. Any condition occurring during pregnancy, childbirth, or the puerperium is considered to be a complication unless the provider specifically documents that it is not.

    Assign code 493.22, Chronic obstructive asthma, with (acute) exacerbation, code 648.24, Other current conditions in the mother classifiable elsewhere but complicating pregnancy, childbirth, or the puerperium, Anemia, postpartum condition or complication; code 285.9, Anemia unspecified; code 642.94, Unspecified hypertension complicating pregnancy, childbirth, or the puerperium, postpartum condition or complication; and code V15.82, History of tobacco use, as additional diagnoses.

    ©*Copyright 1984-2009, American Hospital Association ("AHA"), Chicago, Illinois. Reproduced with permission. No portion of this publication may be copied without the express, written consent of AHA.

    Faye Brown

    The postpartum period, clinically termed the "puerperium," begins immediately after delivery and includes the subsequent six weeks. A postpartum complication is defined as any complication that occurs during that six-week period. One type of postpartum complication is a puerperal infection--a bacterial infection following childbirth. An estimated 2 to 4 percent of mothers who deliver vaginally may experience some form of puerperal infection. For cesarean delivery, the figure is five to ten times higher. The genital tract is the most common site of infection (e.g., endometritis: 670.1x). Other types of puerperal infections include: major puerperal infection, unspecified (670.0x), sepsis (670.2x), septic thrombophlebitis (670.3x), and other major puerperal infections, such as pelvic cellulitis (670.8x). Postpartum complications that occur during the same admission as the delivery are identified by a fifth digit 2. Fifth digit 4 is used for a postpartum complication that occurs after discharge.

    Hope this helps.
    Anna Weaver, CPC, CPMA, CEMC
    Associate Auditor

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