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.
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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