schraffenbert chapter 19 2013 with notes

8/12/2019 Schraffenbert Chapter 19 2013 With Notes

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Basic ICD-10-CM/PCS Coding2013 Edition

Chapter 19:

Certain Conditions Originating in the

Perinatal Period (P00 –

P96)



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Learning Objectives

• Review the chapter’s learning objectives and key

terms

• At the conclusion of this chapter, what must you

know about the coding of certain conditions

originating in the perinatal period?



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Chapter 16 of ICD-10-CM, Certain Conditions

Originating in the Perinatal Period (P00 –P96)

• Codes in Chapter 16 are arranged in the following block:

o P00 – P04 Newborn affected by maternal factors and bycomplications of pregnancy, labor and delivery

o P05 – P08 Disorders of newborn related to length of gestationand fetal growth

o P09 Abnormal findings on neonatal screening

o P10 – P15 Birth trauma



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• Codes in Chapter 16 are arranged in the following block(continued):

o P19 – P29 Respiratory and cardiovascular disorders specific tothe perinatal period

o P35 – P39 Infections specific to the perinatal period

o P50 – P61 Hemorrhagic and hematological disorders of thenewborn

o P70 – P74 Transitory endocrine and metabolic disordersspecific to newborn



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• Conditions coded in chapter 16 of ICD-10-CM describeconditions that begin before birth or develop during thefirst 28 days of life or the perinatal period

• These conditions may continue to exist past the first 28days of life and can be coded regardless of the patient’sage


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• In ICD-10-CM category P00 – P04, newborns affected bymaternal factors and by complications of pregnancy,labor and delivery, the phrase “suspected to be” isincluded in the code title as a nonessential modifier toindicate that the codes are for use when the listedmaternal condition is specified as the cause of theconfirmed or suspected newborn morbidity or potential

morbidity





• Codes for perinatal conditions are organized by type, forexample, disorders related to length of gestation andfetal growth versus conditions produced by birth trauma.

• Other blocks of codes are grouped by the type ofcondition or the body system where the disease is

present



Coding Instructional Notes for

ICD-10-CM, Chapter 16• Codes from Chapter 16 are only for use on the newborn

or infant record, never on the maternal record

• Conditions that have their origin in the fetal or perinatal period (before birth through the first 28 days after birth)

even if morbidity occurs later

• If the condition originated in the perinatal period and

continues throughout the life of the patient, the perinatal

code should continue to be used regardless of the age of

the patient



Coding Instructional Notes for

ICD-10-CM, Chapter 16• Notes in the chapter clarify how codes are to be sequenced. For

example:

o Note under P07: When both birth weight and gestational age of the

newborn are available, both should be coded with the birth weightsequenced before gestational age

• Notes define codes. For example:

o Note under P08.21 define post-term newborn: gestation period over 40

completed weeks to 42 completed weeks



Coding Guidelines for ICD-10-CM,

Chapter 16• NCHS has published chapter-specific guidelines for Chapter 15

that address:

o General perinatal rules

o Observation and evaluation of newborns for suspected conditions not

found

o Coding additional perinatal diagnoses

o Prematurity and fetal growth retardation

o Low birth weight and immaturity statuso Bacterial sepsis of newborn

o Stillbirth



Coding Conditions in ICD-10-CM

Chapter 16• Codes in this chapter describe conditions are used on the

newborn records, never on the maternal records

• Codes identify newborns affected by maternal forces,disorders related to length of gestation and fetal growth,abnormal findings on neonatal screening, birth trauma,infections and conditions in various body systems thatoriginate in the perinatal period




Chapter 16• Newborn Affected by Maternal Forces and by

Complications of Pregnancy, Labor and Delivery (P00 – P04)

o Maternal condition that is the cause or is suspected to be thecause of the newborn’s condition

o Titles of categories include word “suspected” as a nonessentialmodifier




Chapter 16• Newborn Affected by Maternal Forces and by

Complications of Pregnancy, Labor and Delivery (P00 – P04)

o Category P04 identifies through the use of fourth or fifthcharacter the substance (suspected) found to have harmed thefetus or newborn

o Substances include maternal anesthesia, analgesia other

medications, tobacco used as well as the use of alcohol anddrugs of addiction

o Main term in Index: Newborn, affected by (suspected to be)with subterms for the maternal condition affecting newborn




Chapter 16• Disorders of Newborn Related to Length of Gestation

and Fetal Growth (P05 – P08) include

o P05 Disorders of newborn related to slow fetal growthand fetal malnutrition

o P07 Disorders of newborn related to short gestation andlow birth weight, not elsewhere classified

o P08 Disorders of newborn related to long gestation and

high birth weight




Chapter 16• Disorders of Newborn Related to Slow Fetal Growth

and Fetal Malnutrition (P05)

o Infant diagnosed as light-for-dates or light for gestational age

o May also be “small-for-dates” babies

o Another term used is “fetal growth retardation” (FGR)

o P05.0, Newborn light for gestational age

o P05.1, Newborn small for gestational age

• Fifth characters are used for both codes to identify the weight of theinfant at birth



Coding Conditions of ICD-10-CM

Chapter 16• Disorders of Newborn Related to Short Gestation and

Low Birth Weight, Not Elsewhere Classified (P07)

o

Two subcategories identify low birth weight• P07.0 Extremely low birth weight newborn

o Codes describe birth weight of 999 grams or less

• P07.1 Other low birth weight newborno Codes describe birth weight of 1000-2499 grams




Chapter 16• Disorders of Newborn Related to Short Gestation and

Low Birth Weight, Not Elsewhere Classified (P07)

o

Two subcategories identify short gestational age• P07.2 Extreme immaturity of newborn

o Less than 28 completed weeks or less than 196 completed days ofgestation

• P07.3 Preterm (premature) newborn

o 28 completed weeks or more but less than 37 completed weeks or196 completed days but less than 259 completed days of gestation




Chapter 16• Disorders of Newborn Related to Long Gestation and

High Birth Weight (P08)

o May be described as a large baby or extremely large baby

o Other phrases are heavy-for-dates or large-for-dates

o Assignment of the code for birth weight should take priorityover the estimate gestational age code

o Physicians must document the condition in order for it to be

coded




Chapter 16• Disorders of Newborn Related to Long Gestation and High Birth

Weight (P08)o P08.0, Exceptionally large newborn is used for a baby with birth weight of

4500 grams or moreo P08.8 is used for birth weight between 4000 and 4499 grams

o P08.2 is used for “late newborn,” not heavy for gestational age with fifthcharacters for the number of completed weeks of gestational age

o Main terms used in the Index include premature newborn, pretermnewborn, immaturity, small-for-dates, light-for-date, low birth weight,heavy-for-dates and large baby



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Chapter 16• Conditions Associated with Meconium

o Meconium is a thick substance that lines the infant’s intestineduring gestation and consists of a combination of swallowed

amniotic fluid and mucus form the baby.o Baby can pass meconium out of their bowel prior to birth

which is excreted into the amniotic fluid.

• Passage in utero will show the amniotic fluid as having meconiumstaining and baby will be watch closely for fetal distress

• Meconium aspiration syndrome occurs when meconium is aspirated bythe infant into their lungs with their first breath



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Chapter 16• Conditions Associated with Meconium

o Distinct codes for different conditions involving meconium

o P03.82 Meconium passage during delivery

o P24.00 Meconium aspiration without respiratory symptoms

o P24.01 Meconium aspiration with respiratory symptoms(aspiration syndrome)

o P76.0 Meconium ileus (plug syndrome)

o P78.0 Meconium peritonitis

o P96.83 Meconium staining (of amniotic fluid)



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Chapter 16• Respiratory and Cardiovascular Disorders Specific to

the Perinatal Period (P19 – P29)

o Example is respiratory distress syndrome (RDS) of newborn

• P22.0 Respiratory distress syndrome of newborn. This is RDS or RDStype I

• P22.1 Transient tachypnea of newborn which is used for RDS type II,idiopathic tachypnea of newborn or wet lung syndrome

o Other conditions are coded with

• Category P24, neonatal aspiration with fifth-characters of 0 for withoutrespiratory symptoms and 1 for with respiratory symptoms



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Chapter 16• Respiratory and Cardiovascular Disorders Specific to

the Perinatal Period (P19 – P29)o Category P29, Cardiovascular disorders, contain neonatal cardiac

conditions.o Infants with bradycardia or tachycardia after birth may have an underlying

condition but not immediately known and coded as

• P29.11 Neonatal tachycardia

• P29.12 Neonatal bradycardia

o Persistent fetal circulation, P29.3, is used for conditions described asdelayed closure of ductus arteriosus or persistent pulmonary hypertensionof newborn



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Chapter 16• Infections Specific to the Perinatal Period (P35 – P39)

o Category P36, bacterial sepsis of newborn, contains codes frequently to

classify conditions in newborns with infections

o Unique codes exist for septicemia or sepsis of newborn due to variousorganisms. If the P36 does not include the causal organism, the codershould assign an additional code from category B96 to identify organism

o If the infant has severe sepsis, the coder should assign an additional code toidentify severe sepsis and any associated acute organ dysfunction




Chapter 16• Liveborn Infants According to Place of Birth and Type of

Delivery (Z38)o Birth episode is coded with a code from category Z38, Liveborn infants

according to place of birth and type of deliveryo Z38 codes identify the number of liveborn infants, where the infant was

born (in or outside hospital) and how they were delivered (vaginally or bycesarean)

o Z38 code is assigned only once to a newborn at the time of birth

o Main term in Index is “newborn” with subterms to be reviewed

schraffenbert chapter 19 2013 with notes

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