Tag Archives: obs
December 15, 2011 Manual Removal of Retained Placenta by Gentle Cord Traction
Q. When manual removal of a retained placenta by gentle traction on the cord by midwife occurs, should this be reported in an OPCS-4 code?
A. It is assumed that this procedure, when performed, forms part of the management of ‘normal’ delivery. Removal by gentle traction on the cord cannot, therefore, be reported with an OPCS-4 code. This type of management should not be confused with manual removal of retained placenta, which includes insertion of a hand into the uterus (OPCS-4 code R29.1 Manual removal of placenta from delivered uterus) and usually requires anaesthesia.
No code necessary.
Date published: 12/1993 (Issue 12)
Coding Clinic, NHS Classifications Service
www.connectingforhealth.nhs.uk/codingclinic
Tags: female genital tract, MROP, obs, obstetrics
December 14, 2011 Face to Pubes Presentation
Q. What ICD-10 code do I assign for a face to pubes presentation that does not cause an obstructed labour?
A. If the face to pubes presentation does not cause an obstructed labour, then it should not be recorded, as it does not cause a problem with delivery. ICD-10 code O64.0 Obstructed labour due to incomplete rotation of fetal head, (which includes a face to pubes presentation causing obstructed labour) does not have an equivalent within the ICD-10 category O32 Maternal care for known or suspected malpresentation of fetus (not causing obstructed labour). This means that, within the ICD-10 classification, face to pubes presentation is not regarded as a codeable condition unless it causes obstructed labour.
The UK Coding Review Panel, having taken account of clinical opinion, recommends that the code 032.3 be deleted from the index, as below:
Presentation, fetal
– face (mother)
– – to pubes O32.3
– – – causing obstructed labour O64.0
Date published: 04/2001 (Issue 49)
Coding Clinic, NHS Classifications Service
www.connectingforhealth.nhs.uk/codingclinic
Tags: face to pubes, obs, obstetrics, obstructed labour
December 14, 2011 Group B Streptococcus Bacterial Infections
Group B Streptococcus (GBS) has been recognised as the primary cause of bacterial infection in new-born babies, resulting in disease at birth and up to three months of age. It is the most common cause of meningitis in new-borns.
It also causes illness in pregnant women, the elderly, and in adults with other diseases such as diabetes or liver disease. This bacterium is normally found in the vagina and/or lower intestine of 10-30% of all healthy, adult women. Those patients who test positive for GBS are said to be colonised.
GBS is diagnosed by a laboratory test of blood or spinal fluid, or by swab or urine analysis. GBS should not be confused with Group A Streptococcus, which causes strep throat and severe maternal sepsis after delivery. GBS can be present in a woman’s first pregnancy, or in subsequent pregnancies. It can be a threat during pregnancy, at the time of delivery and afterwards.
The majority of GBS infections are acquired during childbirth when the baby comes into direct contact with the bacteria carried by the mother, either by the bacteria travelling upward from the mother’s vagina into the uterus, or as the infant passes through the birth canal. Illness occurs when the bacterium enters the baby’s bloodstream. Some doctors routinely screen for GBS by taking cultures, during pregnancy, from the lower vagina or rectum, or the cervix. Women who are found to carry the bacteria can then be treated as potential GBS risk patients.
A mother colonised with GBS, would be coded as:
Z22.3 Carrier of other specified bacterial diseases
A newborn baby diagnosed with GBS by blood test or spinal fluid, would be coded as:
P36.0 Sepsis of newborn due to streptococcus, group B
Z38.0 Singleton, born in hospital
A newborn baby receiving prophylactic antibiotics whose mother has previously had a streptococcus infection, would be coded as:
Z38.0 Singleton, born in hospital
Z29.2 Other prophylactic chemotherapy
Z83.1 Family history of other infectious and parasitic diseases
A newborn baby whose umbilical swab, or other surface swabs, for example: ear, skin eye etc, is found to be positive for streptococcus Group B with no signs of infection, would be coded as:
Z38.0 Singleton, born in hospital
Z22.3 Carrier of other specified bacterial diseases
Date published: 11/2004 (Volume 1 Issue 3)
Coding Clinic, NHS Classifications Service
www.connectingforhealth.nhs.uk/codingclinic
Tags: GBS, neonatology, obs, obstetrics, streptococcus, z codes
December 14, 2011 Vaginal Thrush in Pregnancy
Q. What are the correct ICD-10 codes to record vaginal thrush in pregnancy?
A. The correct ICD-10 codes for vaginal thrush in pregnancy are:
O23.5 Infections of the genital tract in pregnancy
B37.3† Candidiasis of vulva and vagina (N77.1*)
N77.1* Vaginitis, vulvitis and vulvovaginitis in infectious and parasitic diseases classified elsewhere
Date published: 06/2008 (Volume 5 Issue 1)
Coding Clinic, NHS Classifications Service
www.connectingforhealth.nhs.uk/codingclinic
Tags: candidiasis, infectious diseases, obs, obstetrics, vaginal thrush
December 14, 2011 Obstetric Cholestasis
Q. What is the correct ICD-10 code assignment for obstetric cholestasis?
A. Obstetric cholestasis (sometimes referred to as “cholestasis of pregnancy”, “OC”, “intrahepatic cholestasis of pregnancy” or “ICP”) is a condition of the liver which occurs in some pregnant women.
In cholestasis, there is a reduced flow of bile down the bile ducts in the liver. Some of the bile then ‘leaks’ out into the bloodstream, in particular the bile salts. These circulate in the bloodstream and cause symptoms such as itching. As this is a condition predominantly related to pregnancy, the appropriate ICD-10 codes for obstetric cholestasis are:
O26.6 Liver disorders in pregnancy, childbirth and the puerperium
K83.1 Obstruction of bile duct
Date published: 02/2009 (Volume 5 Issue 3)
Coding Clinic, NHS Classifications Service
www.connectingforhealth.nhs.uk/codingclinic
Tags: cholestasis, obs, obstetrics
December 14, 2011 Elective Caesarean for HIV
Q. Can you please advise which ICD-10 codes should be assigned to the mother’s episode of care when a baby is delivered by elective caesarean, because the mother has been diagnosed with HIV?
A. If the patient is asymptomatic HIV positive, and the HIV is not causing any current medical problems, then the appropriate ICD-10 codes are:
O82.0 Delivery by elective caesarean section
Z37.0 Single live birth
Z21.X Asymptomatic human immunodeficiency virus [HIV] infection status
However if, the patient is suffering from active HIV and this is causing associated medical problems, then the appropriate ICD-10 codes are:
O82.0 Delivery by elective caesarean section
Z37.0 Single live birth
B20-B24 Human immunodeficiency virus [HIV] disease (plus any associated problems, including asterisk codes where necessary).
Note: Human immunodeficiency virus [HIV] disease (B20-B24) is referred to at the Exclusion Note at ICD-10 category O98.- Maternal infectious and parasitic diseases classifiable elsewhere but complicating pregnancy, childbirth and the puerperium.
Date published: 02/2009 (Volume 5 Issue 3)
Coding Clinic, NHS Classifications Service
www.connectingforhealth.nhs.uk/codingclinic
Tags: caesarean, HIV, obs, obstetrics
December 13, 2011 Supervision of Normal Pregnancy
Q. What is the correct ICD-10 code assignment for a patient with a normal pregnancy who is admitted in the early stages of labour, but is subsequently discharged and told to return when the contractions become more established?
A. Provided that the patient has no other condition that is classifiable to ICD-10 Chapter XV Pregnancy, childbirth and the puerperium, and the clinician has stated that the patient is in the early stages of labour, then the correct ICD-10 code for this situation is Z34.- Supervision of normal pregnancy, with the appropriate fourth- character (depending on whether it is a first or subsequent pregnancy).
It is not appropriate to assign Z34.- Supervision of normal pregnancy, when the clinician has made a diagnosis of Braxton-Hicks contractions or false labour. Both of these conditions are classified to category O47.- False labour. Please see page XV-30 of the ICD-10 Clinical Coding Instruction Manual (Version 2.0) for further guidance.
Date published: 06/2009 (Volume 6 Issue 1)
Coding Clinic, NHS Classifications Service
www.connectingforhealth.nhs.uk/codingclinic
Tags: early labour, obs, obstetrics, z codes
December 13, 2011 Administration of Abortifacients for a Missed Abortion
The following guidance must now be used for coding a patient in ICD-10 who is admitted to a ward to receive an abortifacient medication to abort a retained dead fetus before 24 weeks of gestation (missed abortion) with no signs of spontaneous abortion.
a) A patient with a missed abortion is given abortifacient medication and discharged home prior to aborting the fetus; for this scenario, the correct ICD- 10 code for PRIMARY diagnosis is O02.1 Missed abortion, which is followed by Z30.3 Menstrual extraction in a secondary position.
(Note: Z30.3 Menstrual extraction was chosen because it has the inclusion term ‘Interception of pregnancy’.)
Or
b) The abortion takes place on the same episode as administration of the abortifacient medication, or in a subsequent episode during the same admission. For this scenario, the only ICD-10 code required is a PRIMARY diagnosis of O02.1 Missed abortion.
This guidance for abortion of a retained dead fetus is in addition to that given in the ICD-10 Clinical Coding Instruction Manual (Version 2.0), page XV-20 for abortion of live fetus.
Date published: 01/2010 (Volume 6 Issue 4)
Coding Clinic, NHS Classifications Service
www.connectingforhealth.nhs.uk/codingclinic
Tags: abortifacients, missed abortion, obs, obstetrics
December 13, 2011 Vaginal Delivery Following Previous Caesarean Section
Q. Is it appropriate to assign ICD-10 code O75.7 Vaginal delivery following previous caesarean section, on all patients who deliver vaginally following a previous caesarean section?
A. The biggest cause for concern for mothers who deliver vaginally following a previous caesarean section is that the existing caesarean scar may rupture during labour. During the delivery episode both mother and baby will require close monitoring throughout the labour to ensure that any problems are identified and treated before delivery commences. Consequently, a caesarean section previous to a current vaginal delivery must always be considered a complication.
Therefore, if it is documented in the patients medical record that the mother has delivered vaginally following previous caesarean section (regardless of how far in the past that caesarean section was), then it is appropriate to assign ICD-10 code O75.7 Vaginal delivery following previous caesarean section, in either a primary or secondary position, depending on whether ‘vaginal delivery following previous caesarean section’ is the main condition treated during the episode of care.
Date published: 06/2010 (Volume 7 Issue 3)
Coding Clinic, NHS Classifications Service
www.connectingforhealth.nhs.uk/codingclinic
Related articles
- Caesarian or natural birth – which is safer? (guardian.co.uk)
- NHS caesarean guidelines aim to push down demand for procedure (guardian.co.uk)
Tags: obs, obstetrics, VBAC
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