CODES.AND.STUFF

The following guidance applies on occasions when a code is not available to clearly classify that the condition in question forms a perinatal condition.

Conditions arising in the perinatal period should, as far as possible, be coded to Chapter XVI Certain conditions originating in the perinatal period, even when morbidity or death occurs later. This takes precedence over chapters containing codes for diseases by their anatomical site.

This excludes:

• Congenital malformations, deformations and chromosomal abnormalities (Q00-Q99)
• Endocrine, nutritional and metabolic diseases (E00-E90)
• Injury, poisoning, and certain other consequences of external causes (S00-T98)
• Neoplasms (C00-D48)
• Tetanus neonatorum (A33)
• Symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified (R00-R99)

However, if the code for the disease by the anatomical site provides additional information which is not contained in the code from Chapter XVI, then it is acceptable to use a second code to express this information. This provides additional information for the coder and for potential analysis.

Example 1:

Newborn born in hospital with thrombolic occlusion of left superficial femoral artery.

The appropriate ICD-10 codes would be:

P29.8 Other cardiovascular disorders originating in the perinatal period

Z38.0 Singleton, born in hospital

I74.3    Embolism and thrombosis of arteries of lower extremities

Rationale: In order to show that the thrombolic occlusion is a perinatal condition, a code from Chapter XVI must be assigned in the primary position. Code I74.3 Embolism and thrombosis of arteries of lower extremities is assigned to specifically identify that the cardiovascular disorder is thrombolic occlusion. A code from Category Z38.- must be sequenced in the first secondary position as stated on page XVI-4 of the ICD-10 Clinical Coding Instruction Manual (Version 2.0).

Example 2:

Newborn born in hospital, noted to have a birthmark on their right buttock, but no treatment given or further investigations carried out.

The appropriate ICD-10 codes would be:

Z38.0 Singleton, born in hospital

Q82.5 Congenital non-neoplastic naevus

Rationale: In this example the newborn did not receive any treatment or further investigations for the birthmark. Therefore, the primary diagnosis is code Z38.0 Singleton, born in hospital. The birthmark is an incidental finding and must be recorded in a secondary position. If the birthmark was treated or investigated during the birth episode, then it must be sequenced in the primary diagnosis position. This follows the primary diagnosis definition, and the guidance regarding the sequencing of Z38.-, which can be found on page 3 and page XVI-4 of the ICD-10 Clinical Coding Instruction Manual (Version 2.0) respectively.

Example 3:

Newborn born in hospital, noted to be jittery. Blood sugar levels were tested which were within normal limits. The jitteriness subsided and baby and mother were discharged home.

The appropriate ICD-10 codes would be:

R25.8 Other and unspecified abnormal involuntary movements

Z38.0 Singleton, born in hospital

Rationale: In this example the newborn was investigated for the jittery state, therefore it is appropriate to assign the code for a ‘jittery baby’ as the primary diagnosis. This follows the primary diagnosis definition, and the guidance regarding the sequencing of Z38.-, which can be found on page 3 and page XVI-4 of the ICD- 10 Clinical Coding Instruction Manual (Version 2.0) respectively. There is no requirement to assign a code from Chapter XVI Certain conditions originating in the perinatal period as codes in Chapter XVIII Symptoms, signs and abnormal clinical laboratory findings, not elsewhere classified are contained within the list of exclusions above.

Guidance regarding the correct code assignment for a ‘jittery baby’ can be found on page XVIII-10 of the ICD-10 Clinical Coding Instruction manual (Version 2.0).

Update history

12/2011: The guidance originally published in 06/2008 and the update published in 04/2010 have been compiled to form a single piece of guidance to
avoid confusion.

04/2010: The update includes the addition of codes from Chapter XVIII (R00-R99) to the list of excluded codes and the addition of examples and rationales.

Coding Clinic, NHS Classifications Service

www.connectingforhealth.nhs.uk/codingclinic

Tags: neonatal, perinatal