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June 26, 2006
The postpartum period is the six-week time frame beginning immediately following delivery. Any condition occurring during this time is considered a postpartum complication unless the physician specifically documents otherwise. For example, if a patient is admitted four weeks postdelivery with mastitis, assign code 675.24 as it is considered a postpartum complication because the mastitis occurred within the six-week time frame. If a condition occurs outside the six-week window but the physician documents the condition as pregnancy related, it is still coded as a postpartum complication. Therefore, using the above example, if the mastitis occurred eight weeks after delivery and the physician stated it was a postpartum complication, assign code 675.24 (AHA Coding Clinic for ICD-9-CM, 2006, first quarter, page 58). However, if the physician documents that the condition is not pregnancy-related, it is not assigned a postpartum code even if it occurred within six weeks of delivery. For example, a patient is admitted three weeks postdelivery with acute appendicitis. The physician specifically documents that the appendicitis is not a postpartum complication. Therefore, code 540.9 is sequenced as the principal diagnosis. “It is the provider’s responsibility to state that the condition being treated is not affecting the pregnancy” (AHA Coding Clinic for ICD-9-CM, 2006, first quarter, page 54). Fifth-Digit Subclassification Use the fifth digit “2” when the postpartum complication occurred during the same admission as the delivery. Fifth digit “4” is used when the patient has a subsequent admission after delivery for a postpartum complication. Additional Code Assignment Therefore, if the pregnancy code does not provide information on the condition, then an additional code for the specific condition may be assigned. For example, code 646.6x identifies an infection of the genitourinary tract in pregnancy, but it does not identify the specific type of infection such as pyelonephritis, cystitis, urethritis, or urinary tract infection. An additional code may be assigned to specify the complication. On the other hand, code 675.1x completely identifies abscess of breast in pregnancy. No additional code is needed because it would not provide any more detail. Postpartum Depression • postpartum blues; • postpartum depression; and • postpartum psychosis. Postpartum blues is a common, mild depression in mothers of newborns. It can last for a few days to a few weeks. The patient feels sadness, anger, anxiety, irritability, and incompetence. Postpartum depression is more severe than the baby blues. The symptoms are more intense, last longer, and can occur anytime in the first year after birth. In addition to the symptoms of baby blues, postpartum depression symptoms may include the following: • constant fatigue; • lack of joy in life; • emotional numbness; • withdrawal from family and friends; • lack of concern for self and baby; • severe insomnia; • sense of failure and inadequacy; and • severe mood swings. Treatment may include counseling, antidepressant medications, and hormone therapy. Postpartum psychosis is the rarest but most severe form of postpartum depression. It can begin days or weeks after childbirth. Symptoms include the following: • severe depression; • acute anxiety; • racing thoughts or conversations; • fear of harming self or baby; • hallucinations; • irrational thoughts or statements; • paranoia; and • hysteria. Code 648.4x includes the three types of postpartum depression disorders. A secondary diagnosis code will be assigned to identify the depressive disorder as blues, depression, or psychosis. Postpartum blues and postpartum depression are assigned to codes 648.4x + 311. Postpartum psychosis is assigned to codes 648.4x + a code from category 296. Coding and sequencing for postpartum disorders are dependent on the physician documentation in the medical record and application of the Official Coding Guidelines for inpatient care. Also, use specific AHA Coding Clinic for ICD-9-CM and American Medical Association CPT Assistant references to ensure complete and accurate coding. — This information was prepared by Audrey
Howard, RHIA, of 3M Consulting Services. 3M Consulting Services is a
business of 3M Health Information Systems, a supplier of coding and
classification systems to nearly 5,000 healthcare providers. The company
and its representatives do not assume any responsibility for reimbursement
decisions or claims denials made by providers or payors as the result
of the misuse of this coding information. More information about 3M
Health Information Systems is available at www.3mhis.com
or by calling 800-367-2447.
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