Coding of Fetal Deaths October 2009. A desire for further guidance in the coding of Fetal Death...

Coding of

Fetal Deaths

October 2009

A desire for further guidance in the coding of Fetal Death records was expressed at the NAPHSIS conference this past June. This presentation will attempt to fulfill that request.

Click the left mouse button to move through the slides. Click the Esc button on the keyboard to quit at any time.

Please have the following material ready:

•2009 ICD Volumes 1 and 3 (or Perinatal Subset)

•2009 Instruction Manual Part 2c, ICD-10 ACME Decision Tables

•Procedures for Coding Cause of Fetal Death Under ICD-10, Last revised 11/15/2005

This document can be accessed at the following link:

ftp://ftp.cdc.gov/pub/Health_Statistics/NCHS/Dataset_Documentation/NVSS/fetal_death_2003/



This presentation will:

•Help the user become more familiar with the Procedures for Coding Cause of Fetal Death document

•Demonstrate coding of specific examples

•Provide examples to code for anyone desiring further practice

The document Procedures for Coding Cause of Fetal Death Under ICD-10 is based on the 2003 revision of the US Standard Report of Fetal Death.

This certificate can be accessed at the following link:http://www.cdc.gov/nchs/data/dvs/FDEATH11-03finalACC.pdf

http://www.cdc.gov/nchs/data/dvs/FDEATH11-03finalACC.pdf

http://www.cdc.gov/nchs/data/dvs/FDEATH11-03finalACC.pdf

Please refer to the Procedures for Coding Causeof Fetal Death document.

The second paragraph of the instruction document contains the definition of Fetal Death:

‘‘Fetal death’’ means death prior to the complete expulsion or extraction from its mother of a product of human conception, irrespective of the duration of pregnancy and which is not an induced termination of pregnancy.……….

The rules for selection of the initiating cause are listed on the second page. These are very similar to the rules used in underlying cause-of-death coding and involve use of the 2c ACME Decision Tables.

The first step is summarized below. The other steps, can be recognized from the underlying cause-of-death rules and are listed on the next slide.

Step 1, summarizedSelect the first condition reported in Section 18a of the death certificate, or if the terminology “due to” is used, select the condition that is stated as causing the other.

Remaining StepsStep 2 – DSStep 3 – Ill-defined conditionsStep 4 – Trivial conditionsStep 5 – LinkageStep 6 – SpecificityStep 7 – Early and late stages of disease

The third page of the document containsinformation about

Live Births and Abortions

Both are sometimes included in the Fetal Death file in error.

Live births and induced terminations of pregnancy are excluded from the fetal death file

Do include in the fetal file: induced terminations if fetus died before procedure

and procedure done to removean already dead fetus

Don’t include in the fetal file: induced terminations if fetus died during or after

procedure

There are 3 tables at the end of the instruction document. Take special note of Table 3 Terms Indicating Induced Abortions.

Records with these terms reported are excluded from the Fetal Death File.

A few additional terms that can also be considered Induced Terminations of Pregnancy but arenot on the list are:

•Medical interruption of pregnancy•Elective termination•Medically indicated termination of pregnancy•Inevitable abortion

The following certificates have been coded and include explanations based on use of the NCHS Volume 3. Please review carefully to ensure understanding of basic Fetal Death coding guidelines.

18a. INITIATING CAUSE/CONDITION(AMONG THE CHOICES BELOW, PLEASE SELECT THE ONE WHICH MOST LIKELY BEGAN THE SEQUENCE OF EVENTS RESULTING IN THE DEATH OF THE FETUS)Maternal Conditions/Diseases (Specify)___________________Complications of Placenta, Cord or Membranes□ Rupture of membranes prior to onset of labor□ Abruptio placenta□ Placental insufficiency□ Prolapsed cord□ Chorioamnionitis□ Other (Specify)_____________________________Other Obstetrical or Pregnancy Complications (Specify)_______________________________Fetal Anomaly (Specify)________________________Fetal Injury (Specify)__________________________Fetal Infection (Specify)________________________Other Fetal Conditions/Disorders

(Specify) _____Fetal Hydrops______□ Unknown

18b. OTHER SIGNIFICANT CAUSES OR CONDITIONS(SELECT OR SPECIFY ALL OTHER CONDITIONS CONTRIBUTING TO DEATH IN ITEM 18b)Maternal Conditions/Diseases (Specify)_____________________________Complications of Placenta, Cord or Membranes□ Rupture of membranes prior to onset of labor□ Abruptio placenta□ Placental insufficiency□ Prolapsed cord□ Chorioamnionitis□ Other (Specify)_______________________________Other Obstetrical or Pregnancy Complications (Specify)________________________________Fetal Anomaly (Specify)_________________________

__________Turners Syndrome____Fetal Injury (Specify)_____________________Fetal Infection (Specify)___________________Other Fetal Conditions/Disorders

(Specify)___Cystic Hygroma_______□ Unknown

Example 1

Codes: 18a. P832 IC: P832 Steps: 118b. Q969 D181

Code as indexed: Hydrops - fetal(is) or newborn P832

Turner’s - syndrome Q969

Hygroma (cystic) D181

Select P832 by Step 1. No other steps apply.


(Specify) __Cardiac arrest, in utero__□ Unknown

18b. OTHER SIGNIFICANT CAUSES OR CONDITIONS(SELECT OR SPECIFY ALL OTHER CONDITIONS CONTRIBUTING TO DEATH IN ITEM 18b)Maternal Conditions/Diseases (Specify)_____________________________Complications of Placenta, Cord or Membranes□ Rupture of membranes prior to onset of labor□ Abruptio placenta□ Placental insufficiency□ Prolapsed cord□ Chorioamnionitis□ Other (Specify)_______________________________Other Obstetrical or Pregnancy Complications (Specify)________________________________Fetal Anomaly (Specify)__________________

____Dysplastic unilateral kidney_

____Double outlet right ventricle__Fetal Injury (Specify)_____________________Fetal Infection (Specify)___________________Other Fetal Conditions/Disorders (Specify)_____________________________□ Unknown

Example 2

Codes: 18a. P291 IC: Q201 Steps: 1,218b. Q614 Q600 Q201

Code as indexed: Arrest - cardiac

- - newborn P291

Dysplasia - kidney Q614

Unilateral - organ or site, congenital NEC – see Agenesis, by siteAgenesis - kidney - - unilateral Q600

Double - outlet - - right ventricle Q201

Select P291 by Step 1. In Modification Table E, P291 is a DS to Q201. Select Q201 by Step 2.

18a. INITIATING CAUSE/CONDITION(AMONG THE CHOICES BELOW, PLEASE SELECT THE ONE WHICH MOST LIKELY BEGAN THE SEQUENCE OF EVENTS RESULTING IN THE DEATH OF THE FETUS)Maternal Conditions/Diseases (Specify)___________________Complications of Placenta, Cord or Membranes□ Rupture of membranes prior to onset of labor□ Abruptio placenta□ Placental insufficiency□ Prolapsed cord□ Chorioamnionitis□ Other (Specify)_____________________________Other Obstetrical or Pregnancy Complications (Specify)_______________________________Fetal Anomaly (Specify)________________________

Fetal Injury (Specify)___ Fetal Anoxia __Fetal Infection (Specify)________________________Other Fetal Conditions/Disorders (Specify) ______________________□ Unknown

18b. OTHER SIGNIFICANT CAUSES OR CONDITIONS(SELECT OR SPECIFY ALL OTHER CONDITIONS CONTRIBUTING TO DEATH IN ITEM 18b)Maternal Conditions/Diseases (Specify)_____________________________Complications of Placenta, Cord or Membranes□ Rupture of membranes prior to onset of labor□ Abruptio placenta□ Placental insufficiency□ Prolapsed cord□ Chorioamnionitis

X Other (Specify)_ Strangulation_____

_______________umbilical cord______Other Obstetrical or Pregnancy Complications (Specify)________________________________Fetal Anomaly (Specify)_________________________ ______________Fetal Injury (Specify)_____________________Fetal Infection (Specify)___________________Other Fetal Conditions/Disorders (Specify)_____________________□ Unknown

Example 3

Codes: 18a. P209 IC: P025 Steps: 1, 318b. P025

Code as indexed: Anoxia (See also Hypoxia)Hypoxia - fetal – see Distress, fetalDistress - fetal (syndrome) P20.-Go to Volume 1 to select 4th character .9.

Strangulation - umbilical cord - see also Compression, umbilical cord P025 - - fetus or newborn P025

Select P209 by Step 1. Since this is one of the ill-defined conditionslisted in Step 3, reselect as though the P209 had not been reported. Select P025 by Step 3.


(Specify) _Interrupted pregnancy_□ Unknown

18b. OTHER SIGNIFICANT CAUSES OR CONDITIONS(SELECT OR SPECIFY ALL OTHER CONDITIONS CONTRIBUTING TO DEATH IN ITEM 18b)Maternal Conditions/Diseases (Specify)_____________________________Complications of Placenta, Cord or Membranes□ Rupture of membranes prior to onset of labor□ Abruptio placenta□ Placental insufficiency□ Prolapsed cord□ Chorioamnionitis□ Other (Specify)_______________________________Other Obstetrical or Pregnancy Complications (Specify)________________________________Fetal Anomaly (Specify)_________________________ _______________________________Fetal Injury (Specify)_____________________Fetal Infection (Specify)___________________Other Fetal Conditions/Disorders (Specify)___________________________□ Unknown

Example 4

Interrupted pregnancy is listed on Table 3, meaning that it is a term that indicates an induced termination of pregnancy. Since this reporting does not meet the definition of fetal death, the record should be deleted from the fetal death file and an appropriate certificate completed. Refer to the third page of the instruction document, the section entitled Inclusions in the File.

18a. INITIATING CAUSE/CONDITION(AMONG THE CHOICES BELOW, PLEASE SELECT THE ONE WHICH MOST LIKELY BEGAN THE SEQUENCE OF EVENTS RESULTING IN THE DEATH OF THE FETUS)Maternal Conditions/Diseases (Specify)___________________Complications of Placenta, Cord or Membranes□ Rupture of membranes prior to onset of labor□ Abruptio placenta□ Placental insufficiency□ Prolapsed cord□ Chorioamnionitis

X Other (Specify)_Cord Accident____Other Obstetrical or Pregnancy Complications (Specify)_______________________________Fetal Anomaly (Specify)________________________Fetal Injury (Specify)__________________________Fetal Infection (Specify)________________________Other Fetal Conditions/Disorders (Specify) ___________□ Unknown

18b. OTHER SIGNIFICANT CAUSES OR CONDITIONS(SELECT OR SPECIFY ALL OTHER CONDITIONS CONTRIBUTING TO DEATH IN ITEM 18b)Maternal Conditions/Diseases (Specify)_____________________________Complications of Placenta, Cord or Membranes□ Rupture of membranes prior to onset of labor□ Abruptio placenta□ Placental insufficiency□ Prolapsed cord□ Chorioamnionitis

X Other (Specify)_Nuchal Cord________Other Obstetrical or Pregnancy Complications (Specify)________________________________Fetal Anomaly (Specify)_________________________ _______________________________Fetal Injury (Specify)_____________________Fetal Infection (Specify)___________________Other Fetal Conditions/Disorders (Specify)_____________________________□ Unknown

Example 5


To be indexed: Accident - cord (umbilical) P026

Code as indexed: Nuchal cord P025

Select P026 by Step 1. In Modification Table E, P026 is an SMP maybe to P025. Ambivalent Table F says “Addr must be unspecified condition of umbilical cord.” Since cord accident meets this criteria, select P025 by Step 6.

The next 9 screens contain examples that can be coded on a separate sheet of paper for practice. Please identify codes, initiating cause (IC), and steps for each record, as in sample below:

Correct answers will appear upon clicking so that you can self-check your results.

Codes: 18a. _______ _______ 18b. _______

_______

IC: ______

Steps:_________

18a. INITIATING CAUSE/CONDITION(AMONG THE CHOICES BELOW, PLEASE SELECT THE ONE WHICH MOST LIKELY BEGAN THE SEQUENCE OF EVENTS RESULTING IN THE DEATH OF THE FETUS)Maternal Conditions/Diseases (Specify)___________________Complications of Placenta, Cord or Membranes

X Rupture of membranes prior to onset of labor□ Abruptio placenta□ Placental insufficiency□ Prolapsed cord□ Chorioamnionitis□ Other (Specify)_____________________________Other Obstetrical or Pregnancy Complications (Specify)_______________________________Fetal Anomaly (Specify)________________________Fetal Injury (Specify)__________________________Fetal Infection (Specify)___________________________Other Fetal Conditions/Disorders (Specify) _________________________□ Unknown


__________Unknown anomaly____Fetal Injury (Specify)_____________________Fetal Infection (Specify)___________________Other Fetal Conditions/Disorders (Specify)_____________________________□ Unknown

Practice Example 1

Codes: 18a. P011 IC: P011 Steps: 118b. Q899

Code as indexed: Rupture - membranes - - premature - - - affecting fetus or newborn P011

Anomaly Q899

Select P011 by Step 1.


(Specify) _Extreme Prematurity____□ Unknown

18b. OTHER SIGNIFICANT CAUSES OR CONDITIONS(SELECT OR SPECIFY ALL OTHER CONDITIONS CONTRIBUTING TO DEATH IN ITEM 18b)Maternal Conditions/Diseases

(Specify)_ Cervical incompetence ____________________________________Complications of Placenta, Cord or Membranes□ Rupture of membranes prior to onset of labor□ Abruptio placenta□ Placental insufficiency□ Prolapsed cord□ Chorioamnionitis□ Other (Specify)_______________________________Other Obstetrical or Pregnancy Complications (Specify)________________________________Fetal Anomaly (Specify)_________________________ _______________________________Fetal Injury (Specify)_____________________Fetal Infection (Specify)___________________Other Fetal Conditions/Disorders (Specify)____________________________□ Unknown

Practice Example 2


Code as indexed: Prematurity - extreme P072

Incompetency, incompetent - cervix

- - in pregnancy - - - affecting fetus or newborn P010

Select P072 by Step 1. Since this is one of the ill-defined conditionslisted in Step 3, reselect as though the P072 had not been reported. Select P010 by Step 3.

18a. INITIATING CAUSE/CONDITION(AMONG THE CHOICES BELOW, PLEASE SELECT THE ONE WHICH MOST LIKELY BEGAN THE SEQUENCE OF EVENTS RESULTING IN THE DEATH OF THE FETUS)Maternal Conditions/Diseases (Specify)___________________Complications of Placenta, Cord or Membranes□ Rupture of membranes prior to onset of labor□ Abruptio placenta□ Placental insufficiency□ Prolapsed cord□ Chorioamnionitis□ Other (Specify)_____________________________Other Obstetrical or Pregnancy Complications (Specify)_______________________________

Fetal Anomaly (Specify)__Multiple Fetal Anomalies_____________________Fetal Injury (Specify)__________________________Fetal Infection (Specify)________________________Other Fetal Conditions/Disorders

(Specify) ______________________ __________________________________□ Unknown

18b. OTHER SIGNIFICANT CAUSES OR CONDITIONS(SELECT OR SPECIFY ALL OTHER CONDITIONS CONTRIBUTING TO DEATH IN ITEM 18b)Maternal Conditions/Diseases (Specify)_____________________________Complications of Placenta, Cord or Membranes□ Rupture of membranes prior to onset of labor□ Abruptio placenta□ Placental insufficiency□ Prolapsed cord□ Chorioamnionitis□ Other (Specify)_______________________________Other Obstetrical or Pregnancy Complications (Specify)________________________________Fetal Anomaly (Specify)_____________

____ Double outlet rt ventricle _____Dysplastic unilateral kidney Fetal Injury (Specify)_____________________Fetal Infection (Specify)___________________Other Fetal Conditions/Disorders (Specify)_____________________________□ Unknown

Practice Example 3

Codes: 18a. Q897 IC: Q201 Steps: 1, 618b. Q201 Q614 Q600

Code as indexed: Anomaly - multiple NEC Q897

Double - outlet - - right ventricle Q201

Dysplasia - kidney Q614

Unilateral - organ or site, congenital NEC – see Agenesis, by siteAgenesis - kidney - - unilateral Q600

Select Q897 by Step 1. In Modification Table E, Q897 is an SMP to all 3 of the other conditions reported. Select the first mentioned, Q201. Since there is no further modification, Q201 is the IC by Step 6.

18a. INITIATING CAUSE/CONDITION(AMONG THE CHOICES BELOW, PLEASE SELECT THE ONE WHICH MOST LIKELY BEGAN THE SEQUENCE OF EVENTS RESULTING IN THE DEATH OF THE FETUS)Maternal Conditions/Diseases (Specify)___________________Complications of Placenta, Cord or Membranes□ Rupture of membranes prior to onset of labor□ Abruptio placenta□ Placental insufficiency□ Prolapsed cord□ Chorioamnionitis□ Other (Specify)_____________________________Other Obstetrical or Pregnancy Complications (Specify)_______________________________

Fetal Anomaly (Specify)____Turners _____Syndrome________________Fetal Injury (Specify)__________________________Fetal Infection (Specify)________________________Other Fetal Conditions/Disorders (Specify) __________□ Unknown

18b. OTHER SIGNIFICANT CAUSES OR CONDITIONS(SELECT OR SPECIFY ALL OTHER CONDITIONS CONTRIBUTING TO DEATH IN ITEM 18b)Maternal Conditions/Diseases (Specify)_____________________________Complications of Placenta, Cord or Membranes□ Rupture of membranes prior to onset of labor□ Abruptio placenta□ Placental insufficiency□ Prolapsed cord□ Chorioamnionitis□ Other (Specify)_______________________________Other Obstetrical or Pregnancy Complications (Specify)________________________________Fetal Anomaly (Specify)_________________________ ______________Fetal Injury (Specify)_____________________Fetal Infection (Specify)___________________Other Fetal Conditions/Disorders

(Specify)__Fetal Hydrops________□ Unknown

Practice Example 4

Codes: 18a. Q969 IC: Q969 Steps: 118b. P832

Code as indexed: Turner’s - syndrome Q969

Hydrops - fetal(is or newborn) P832

Select Q969 by Step 1.

18a. INITIATING CAUSE/CONDITION(AMONG THE CHOICES BELOW, PLEASE SELECT THE ONE WHICH MOST LIKELY BEGAN THE SEQUENCE OF EVENTS RESULTING IN THE DEATH OF THE FETUS)Maternal Conditions/Diseases (Specify)___________________Complications of Placenta, Cord or Membranes□ Rupture of membranes prior to onset of labor□ Abruptio placenta□ Placental insufficiency□ Prolapsed cord□ Chorioamnionitis

X Other (Specify)__ Placenta Previa____Other Obstetrical or Pregnancy Complications (Specify)_______________________________Fetal Anomaly (Specify)________________________Fetal Injury (Specify)__________________________Fetal Infection (Specify)________________________Other Fetal Conditions/Disorders (Specify) _________________________□ Unknown

18b. OTHER SIGNIFICANT CAUSES OR CONDITIONS(SELECT OR SPECIFY ALL OTHER CONDITIONS CONTRIBUTING TO DEATH IN ITEM 18b)Maternal Conditions/Diseases (Specify)_____________________________Complications of Placenta, Cord or Membranes□ Rupture of membranes prior to onset of labor□ Abruptio placenta□ Placental insufficiency□ Prolapsed cord□ Chorioamnionitis□ Other (Specify)_______________________________Other Obstetrical or Pregnancy Complications (Specify)________________________________Fetal Anomaly (Specify)_________________________ ______________Fetal Injury (Specify)_____________________Fetal Infection (Specify)___________________Other Fetal Conditions/Disorders (Specify)_____________________________□ Unknown

Practice Example 5

Codes: 18a. P020 IC: P020 Steps: 1

Code as indexed: Placenta - previa - - affecting fetus or newborn P020



(Specify) _Intrauterine Growth Retardation __________________□ Unknown

18b. OTHER SIGNIFICANT CAUSES OR CONDITIONS(SELECT OR SPECIFY ALL OTHER CONDITIONS CONTRIBUTING TO DEATH IN ITEM 18b)Maternal Conditions/Diseases (Specify)_____________________________Complications of Placenta, Cord or Membranes□ Rupture of membranes prior to onset of labor

X Abruptio placenta□ Placental insufficiency□ Prolapsed cord□ Chorioamnionitis□ Other (Specify)_______________________________Other Obstetrical or Pregnancy Complications (Specify)________________________________Fetal Anomaly (Specify)_________________________ _______________________________Fetal Injury (Specify)_____________________Fetal Infection (Specify)___________________Other Fetal Conditions/Disorders

(Specify)___Oligohydramnios _____□ Unknown

Practice Example 6

Codes: 18a. P059 IC: P059 Steps: 118b. P021 P012

Code as indexed: Retardation - intrauterine growth P059

Abruptio placentae - affecting fetus or newborn P021

Oligohydramnios - affecting fetus or newborn P012



(Specify) _____Intrauterine fetal _____death______□ Unknown

18b. OTHER SIGNIFICANT CAUSES OR CONDITIONS(SELECT OR SPECIFY ALL OTHER CONDITIONS CONTRIBUTING TO DEATH IN ITEM 18b)Maternal Conditions/Diseases (Specify)_____________________________Complications of Placenta, Cord or Membranes□ Rupture of membranes prior to onset of labor□ Abruptio placenta□ Placental insufficiency□ Prolapsed cord□ Chorioamnionitis□ Other (Specify)_______________________________Other Obstetrical or Pregnancy Complications (Specify)________________________________

Fetal Anomaly (Specify)_ Trisomy 18_____ ________________________________Fetal Injury (Specify)_____________________Fetal Infection (Specify)___________________Other Fetal Conditions/Disorders (Specify)_____________________________□ Unknow

Practice Example 7

Codes: 18a. P95 IC: Q913 Steps: 1, 318b. Q913

Code as indexed: Death - fetal (intrauterine) P95

Trisomy - 16-18 (partial) Q913

Select P95 by Step 1. Since this is one of the ill-defined conditionslisted in Step 3, reselect as though the P95 had not been reported. Select Q913 by Step 3.


(Specify) _____Extreme Prematurity__□ Unknown


__________Anencephaly_______Fetal Injury (Specify)_____________________Fetal Infection (Specify)___________________Other Fetal Conditions/Disorders (Specify)____________________________□ Unknown

Practice Example 8

Codes: 18a. P072 IC: Q000 Steps: 1, 318b. Q000

Code as indexed: Prematurity - extreme P072

Anencephaly Q000

Select P072 by Step 1. Since this is one of the ill-defined Conditions listed in Step 3, reselect as though the P072 had not been reported. Select Q000 by Step 3.


(Specify) _Intrauterine Fetal Demise_□ Unknown

18b. OTHER SIGNIFICANT CAUSES OR CONDITIONS(SELECT OR SPECIFY ALL OTHER CONDITIONS CONTRIBUTING TO DEATH IN ITEM 18b)Maternal Conditions/Diseases (Specify)_____________________________Complications of Placenta, Cord or Membranes□ Rupture of membranes prior to onset of labor□ Abruptio placenta□ Placental insufficiency□ Prolapsed cord□ Chorioamnionitis□ Other (Specify)_______________________________Other Obstetrical or Pregnancy Complications (Specify)________________________________Fetal Anomaly (Specify)_________________________Fetal Injury (Specify)_____________________Fetal Infection (Specify)___________________Other Fetal Conditions/Disorders

(Specify)_Knot in umbilical cord ___□ Unknown

Practice Example 9


Code as indexed: Demise - fetal – see Death, fetal Death - fetus, fetal - - in fetal death file P95

Knot, umbilical cord - affecting fetus or newborn P025

Select P95 by Step 1. Since this is one of the ill-defined conditions listed in Step 3, reselect as though the P95 had not been reported. Select P025 by Step 3.

NCHS-RTPOctober 2009

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Coding of Fetal Deaths October 2009. A desire for further guidance in the coding of Fetal Death...

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