Copyright © 2012 by Mosby, an imprint of Elsevier Inc. PREGNANCY, CHILDBIRTH, AND THE PUERPERIUM...

48
Copyright © 2012 by Mosby, an imprint of Elsevier Inc. PREGNANCY, CHILDBIRTH, AND THE PUERPERIUM Chapter Seven

Transcript of Copyright © 2012 by Mosby, an imprint of Elsevier Inc. PREGNANCY, CHILDBIRTH, AND THE PUERPERIUM...

Page 1: Copyright © 2012 by Mosby, an imprint of Elsevier Inc. PREGNANCY, CHILDBIRTH, AND THE PUERPERIUM Chapter Seven.

Copyright © 2012 by Mosby, an imprint of Elsevier Inc.

PREGNANCY, CHILDBIRTH, AND THE PUERPERIUM

Chapter Seven

Page 2: Copyright © 2012 by Mosby, an imprint of Elsevier Inc. PREGNANCY, CHILDBIRTH, AND THE PUERPERIUM Chapter Seven.

2Copyright © 2012 by Mosby, an imprint of Elsevier Inc.

Word Parts

gravid/o, -gravida, -cyesis = pregnancy

nulli- = none

primi- = first

multi- = many

Anatomy and Physiology of Pregnancy

ConceptionCoitus/copulationGestation

Gravida Nulligravida Primigravida Multigravida

Page 3: Copyright © 2012 by Mosby, an imprint of Elsevier Inc. PREGNANCY, CHILDBIRTH, AND THE PUERPERIUM Chapter Seven.

3Copyright © 2012 by Mosby, an imprint of Elsevier Inc.

CM Guideline Alert

15.a. General Rules for Obstetric Cases 1) Codes from Chapter 15 and sequencing priority

Obstetric cases require codes from Chapter 15, codes in the range O00-09a, Pregnancy, Childbirth, and the Puerperium. Chapter 15 codes have sequencing priority over codes from other chapters. Additional codes from other chapters may be used in conjunction with Chapter 15 codes to further specify conditions. Should the provider document that the pregnancy is incidental to the encounter, then code Z33.1, Pregnant state, incidental, should be used in place of any Chapter 15 codes. It is the provider’s responsibility to state that the condition being treated is not affecting the pregnancy.

2) Chapter 15 Codes used only on the maternal record Chapter 15 codes are to be used only on the maternal record,

never on the record of the newborn.

Page 4: Copyright © 2012 by Mosby, an imprint of Elsevier Inc. PREGNANCY, CHILDBIRTH, AND THE PUERPERIUM Chapter Seven.

4Copyright © 2012 by Mosby, an imprint of Elsevier Inc.

Time Periods of Pregnancy

Normal Length EDD LMP

Trimesters

Page 5: Copyright © 2012 by Mosby, an imprint of Elsevier Inc. PREGNANCY, CHILDBIRTH, AND THE PUERPERIUM Chapter Seven.

5Copyright © 2012 by Mosby, an imprint of Elsevier Inc.

CM Guideline Alert

15.a.3 Final Character for Trimester The majority of codes in Chapter 15 have a final character

indicating the trimester of pregnancy. The timeframes for the trimesters are indicated at the beginning of the chapter. If trimester is not a component of a code it is because the condition always occurs in a specific trimester, or the concept of trimester of pregnancy is not applicable. Certain codes have characters for only certain trimesters because the condition does not occur in all trimesters, but it may occur in more than just one.

Assignment of the final character for trimester should be based on the providers documentation of the trimester (or number of weeks) for the current admission/encounter. This applies to the assignment of trimester for pre-existing conditions as well as those that develop during or are due to the pregnancy. The provider’s documentation of the number of weeks of pregnancy may be used to assign the appropriate code identifying the trimester.

Whenever delivery occurs during the current admission, and there is an “in childbirth” option for the obstetric complication being coded, the “in childbirth” code should be assigned.

Page 6: Copyright © 2012 by Mosby, an imprint of Elsevier Inc. PREGNANCY, CHILDBIRTH, AND THE PUERPERIUM Chapter Seven.

6Copyright © 2012 by Mosby, an imprint of Elsevier Inc.

Word Parts

blast/o = embryonic, immature

-cyst = sac

troph/o = development, nourishment

-blast = embryonic, immature

Anatomy of PregnancyZygoteMorulaBlastocyst

Implantation hCG Trophoblast

Page 7: Copyright © 2012 by Mosby, an imprint of Elsevier Inc. PREGNANCY, CHILDBIRTH, AND THE PUERPERIUM Chapter Seven.

7Copyright © 2012 by Mosby, an imprint of Elsevier Inc.

Word Parts

mono- = one

chorion/o = chorion, outer fetal sac

-ic = pertaining to

di- = two

amni/o = amnion, outer fetal sac

-tic = pertaining to

Anatomy of PregnancyTwins

Monozygotic Dizygotic Dichorionic/diamniotic Monochorionic/diamniotic Monochorionic/monoamniotic Conjoined twins

Page 8: Copyright © 2012 by Mosby, an imprint of Elsevier Inc. PREGNANCY, CHILDBIRTH, AND THE PUERPERIUM Chapter Seven.

8Copyright © 2012 by Mosby, an imprint of Elsevier Inc.

Review Question

A woman who is a nulligravida:A. has never been pregnantB. has been pregnant onceC. has been pregnant two or more times

Page 9: Copyright © 2012 by Mosby, an imprint of Elsevier Inc. PREGNANCY, CHILDBIRTH, AND THE PUERPERIUM Chapter Seven.

9Copyright © 2012 by Mosby, an imprint of Elsevier Inc.

Word Parts

fet/o = fetus

post- = after

Anatomical Development and Trimesters

Zygote 3 weeks

Embryo 3-8 weeks

Fetus >8 weeks Trimester development Term pregnancy Post-term

40-42 weeks Prolonged pregnancy

>42 weeks

Page 10: Copyright © 2012 by Mosby, an imprint of Elsevier Inc. PREGNANCY, CHILDBIRTH, AND THE PUERPERIUM Chapter Seven.

10Copyright © 2012 by Mosby, an imprint of Elsevier Inc.

Word Parts

extra- = outside

chori/o, chorion/o =

chorion

placent/o = placenta

amni/o = amnion

umbilic/o, omphal/o = umbilicucs

Extraembryonic MembranesAmnion

Amniotic fluid Allantois Umbilical cord

Chorion Placenta Chorionic villi

Uterus of a pregnant woman

Page 11: Copyright © 2012 by Mosby, an imprint of Elsevier Inc. PREGNANCY, CHILDBIRTH, AND THE PUERPERIUM Chapter Seven.

11Copyright © 2012 by Mosby, an imprint of Elsevier Inc.

Signs of Pregnancy

Page 12: Copyright © 2012 by Mosby, an imprint of Elsevier Inc. PREGNANCY, CHILDBIRTH, AND THE PUERPERIUM Chapter Seven.

12Copyright © 2012 by Mosby, an imprint of Elsevier Inc.

Word Parts

part/o , -para, -partum = parturition, delivery

ante- = before

intra- = within

nulli- = none

primi- = first

multi- = many

Delivery and ChildbirthParturition

Antepartum Intrapartum Postpartum

Parity Nullipara Primipara

Young Elderly

Multipara Grand multiparity

Puerperium

Page 13: Copyright © 2012 by Mosby, an imprint of Elsevier Inc. PREGNANCY, CHILDBIRTH, AND THE PUERPERIUM Chapter Seven.

13Copyright © 2012 by Mosby, an imprint of Elsevier Inc.

CM Guideline Alert

15.0. The Peripartum and Postpartum Period1) Peripartum and postpartum periods

The postpartum period begins immediately after delivery and continues for 6 weeks following delivery. The peripartum period is defined as the last month of pregnancy to 5 months postpartum.

2) Peripartum and postpartum complications A postpartum complication is any complication occurring within the

6-week period.

3) pregnancy-related complications after 6-week periodChapter 15 codes may also be used to describe pregnancy –

related complications after the peripartum or postpartum period if the provider documents that a condition is pregnancy related.

Page 14: Copyright © 2012 by Mosby, an imprint of Elsevier Inc. PREGNANCY, CHILDBIRTH, AND THE PUERPERIUM Chapter Seven.

14Copyright © 2012 by Mosby, an imprint of Elsevier Inc.

Review Question

The 6-week time period after a delivery is termed:

A. parturitionB. puerperiumC. gestationD. copulation

Page 15: Copyright © 2012 by Mosby, an imprint of Elsevier Inc. PREGNANCY, CHILDBIRTH, AND THE PUERPERIUM Chapter Seven.

15Copyright © 2012 by Mosby, an imprint of Elsevier Inc.

Word Parts

-tocia = labor

Stages of LaborFirst

Early/latent Active Transitional

SecondThird

Page 16: Copyright © 2012 by Mosby, an imprint of Elsevier Inc. PREGNANCY, CHILDBIRTH, AND THE PUERPERIUM Chapter Seven.

16Copyright © 2012 by Mosby, an imprint of Elsevier Inc.

Word Parts

neo- = new

nat/o = birth

pre- = before

ante- = before

peri- = around

post- = after

BirthNat/o

Neonate Prenatal/antenatal Perinatal Postnatal

Page 17: Copyright © 2012 by Mosby, an imprint of Elsevier Inc. PREGNANCY, CHILDBIRTH, AND THE PUERPERIUM Chapter Seven.

17Copyright © 2012 by Mosby, an imprint of Elsevier Inc.

Newborn Weights and Length of Gestation Terminology

Extremely low birth weightExtreme immaturityOther immaturityLate newborn, not heavy for gestational ageProlonged gestationExceptionally large newbornHeavy for gestational ageLight for gestational age (LGA) vs. small for

gestational age (SMA)

Be Careful! LGA is an abbreviation that has in the past meant “large for gestational age” but which now means “light for gestational age.”

Page 18: Copyright © 2012 by Mosby, an imprint of Elsevier Inc. PREGNANCY, CHILDBIRTH, AND THE PUERPERIUM Chapter Seven.

18Copyright © 2012 by Mosby, an imprint of Elsevier Inc.

CM Guideline Alert

16.d. Prematurity and Fetal Growth Retardation Providers utilize different criteria in determining

prematurity. A code for prematurity should not be assigned unless it is documented. Assignment of codes in categories P05, Disorders of newborn related to slow fetal growth and fetal malnutrition, and P07, Disorders of newborn related to short gestation and low birth weight, not elsewhere classified, should be based on the recorded birth weight and estimated gestational age. Codes from category P05 should not be assigned with codes from category P07.

Page 19: Copyright © 2012 by Mosby, an imprint of Elsevier Inc. PREGNANCY, CHILDBIRTH, AND THE PUERPERIUM Chapter Seven.

19Copyright © 2012 by Mosby, an imprint of Elsevier Inc.

CM Guideline Alert

16.e. Low Birth Weight and Immaturity Status Codes from category P07, disorders of newborn

related to short gestation and low birth weight, not elsewhere classified, are for use for a child or adult who was premature or had a low birth weight as a newborn and this is affecting the patient’s current health status.

Page 20: Copyright © 2012 by Mosby, an imprint of Elsevier Inc. PREGNANCY, CHILDBIRTH, AND THE PUERPERIUM Chapter Seven.

20Copyright © 2012 by Mosby, an imprint of Elsevier Inc.

Special Note

When both birth weight and gestational age of the newborn are available, both should be coded with birth weight sequenced before gestational age.

Page 21: Copyright © 2012 by Mosby, an imprint of Elsevier Inc. PREGNANCY, CHILDBIRTH, AND THE PUERPERIUM Chapter Seven.

21Copyright © 2012 by Mosby, an imprint of Elsevier Inc.

APGAR Score

A: appearanceP: pulseG: grimaceA: activityR: respiration

Page 22: Copyright © 2012 by Mosby, an imprint of Elsevier Inc. PREGNANCY, CHILDBIRTH, AND THE PUERPERIUM Chapter Seven.

22Copyright © 2012 by Mosby, an imprint of Elsevier Inc.

Be Careful!

LGA is an abbreviation that has in the past been used to mean “large for gestational age” but which now means “light for gestational age.”

Page 23: Copyright © 2012 by Mosby, an imprint of Elsevier Inc. PREGNANCY, CHILDBIRTH, AND THE PUERPERIUM Chapter Seven.

23Copyright © 2012 by Mosby, an imprint of Elsevier Inc.

Review Question

Birth takes place during which stage of labor?

A.FirstB.SecondC.ThirdD.Fourth

Page 24: Copyright © 2012 by Mosby, an imprint of Elsevier Inc. PREGNANCY, CHILDBIRTH, AND THE PUERPERIUM Chapter Seven.

24Copyright © 2012 by Mosby, an imprint of Elsevier Inc.

Word Parts

ec- = out

top/o = place

-ic = pertaining to

hydatid/i = water drop

-form = shape

Pregnancy with Abortive Outcome (O00-O08)Ectopic pregnancyHydatidiform moleMiscarriage/abortion

Spontaneous vs. therapeutic Missed Incomplete

Ectopic pregnancy

Page 25: Copyright © 2012 by Mosby, an imprint of Elsevier Inc. PREGNANCY, CHILDBIRTH, AND THE PUERPERIUM Chapter Seven.

25Copyright © 2012 by Mosby, an imprint of Elsevier Inc.

CM Guideline Alert

16.g. Stillbirth Code P95, Stillbirth, is only for use in institutions that

maintain separate records for stillbirths. No other code should be used with P95. code P95 should not be used on the mother’s record.

Page 26: Copyright © 2012 by Mosby, an imprint of Elsevier Inc. PREGNANCY, CHILDBIRTH, AND THE PUERPERIUM Chapter Seven.

26Copyright © 2012 by Mosby, an imprint of Elsevier Inc.

Word Parts

-edema = swelling

hem/o = blood

-lysis = breaking down

pre- = before

Edema, Proteinuria, and Hypertensive Disorders in Pregnancy, Childbirth, and the Puerperium (O10-O16)Eclampsia in pregnancyGestational edemaHELLP syndrome

Hemolysis, elevated liver enzymes, low platelet count

Preeclampsia

Page 27: Copyright © 2012 by Mosby, an imprint of Elsevier Inc. PREGNANCY, CHILDBIRTH, AND THE PUERPERIUM Chapter Seven.

27Copyright © 2012 by Mosby, an imprint of Elsevier Inc.

Word Parts

phleb/o = vein

-it is = inflammation

hyper- = excessive

-emesis = vomiting

gravidarum = pregnancy

prurit/o = itching

Other Maternal Disorders Predominately Related to Pregnancy (O20-)29)Gestational phlebitisHyperemesis gravidarumPUPP

Pruritic urticarial papules and plaques

Page 28: Copyright © 2012 by Mosby, an imprint of Elsevier Inc. PREGNANCY, CHILDBIRTH, AND THE PUERPERIUM Chapter Seven.

28Copyright © 2012 by Mosby, an imprint of Elsevier Inc.

Review Question

Which of the following terms describes a pregnancy that is “out of its (normal) place”?

A. HELLPB. PUPPC. eclampsiaD. ectopic pregnancy

Page 29: Copyright © 2012 by Mosby, an imprint of Elsevier Inc. PREGNANCY, CHILDBIRTH, AND THE PUERPERIUM Chapter Seven.

29Copyright © 2012 by Mosby, an imprint of Elsevier Inc.

Word Parts

cephal/o = head

pelv/i = pelvis

-ic = pertaining to

cervic/o = cervix

-al = pertaining to

mal- = bad, abnormal

The Fetus and Amniotic Cavity and Possible Delivery Problems (O30-O48)Cephalopelvic disproportionCervical incompetenceMalpresentation of fetus

Malpresentation of fetus

Page 30: Copyright © 2012 by Mosby, an imprint of Elsevier Inc. PREGNANCY, CHILDBIRTH, AND THE PUERPERIUM Chapter Seven.

30Copyright © 2012 by Mosby, an imprint of Elsevier Inc.

The Fetus and Amniotic Cavity and Possible Delivery Problems (O30-O48)

Abruptio placentae

Page 31: Copyright © 2012 by Mosby, an imprint of Elsevier Inc. PREGNANCY, CHILDBIRTH, AND THE PUERPERIUM Chapter Seven.

31Copyright © 2012 by Mosby, an imprint of Elsevier Inc.

Word parts

erythr/o = red (blood cell)

blast/o = immature

-osis = abnormal

condition

The Fetus and Amniotic Cavity and Possible Delivery Problems (O30-O48)Twin-to-twin transfusion syndrome (TTTS)Erythroblastosis fetalis

Erythroblastosis fetalis

Page 32: Copyright © 2012 by Mosby, an imprint of Elsevier Inc. PREGNANCY, CHILDBIRTH, AND THE PUERPERIUM Chapter Seven.

32Copyright © 2012 by Mosby, an imprint of Elsevier Inc.

Word Parts

olig/o = scanty

hydr/o = water, fluid

-amnios = amnion

poly- = excessive

chori/o = chorion

amnion/o = amnion

-itis = inflammation

The Fetus and Amniotic Cavity and Possible Delivery Problems (O30-O48)OligohydramniosPolyhydramniosChorioamnionitis

Page 33: Copyright © 2012 by Mosby, an imprint of Elsevier Inc. PREGNANCY, CHILDBIRTH, AND THE PUERPERIUM Chapter Seven.

33Copyright © 2012 by Mosby, an imprint of Elsevier Inc.

Word Parts

placent/o = placenta

-it is = inflammation

previa = in front of

ac- = toward

cret/o = to grow

-a = noun ending

per- = through

in- = in

The Fetus and Amniotic Cavity and Possible Delivery Problems (O30-O48)PlacentitisPlacenta previaPlacenta accretaPlacenta incretaPlacenta percreta

Page 34: Copyright © 2012 by Mosby, an imprint of Elsevier Inc. PREGNANCY, CHILDBIRTH, AND THE PUERPERIUM Chapter Seven.

34Copyright © 2012 by Mosby, an imprint of Elsevier Inc.

Word Parts

nuch/o = neck

-al = pertaining to

dys- = abnormal, difficult

-tocia = labor, childbirth

Complications of Labor and Delivery (O60—O77)Nuchal cordDystocia

Meconium staining

Page 35: Copyright © 2012 by Mosby, an imprint of Elsevier Inc. PREGNANCY, CHILDBIRTH, AND THE PUERPERIUM Chapter Seven.

35Copyright © 2012 by Mosby, an imprint of Elsevier Inc.

Word Parts

a- = without

galact/o = milk

-ia = condition

-rrhea = flow, discharge

hypo- = deficient, below

puerper/o = puerperium

-al = pertaining to

sepsis = infection

Complications Predominantly Related to the Puerperium (O85-O92)AgalactiaGalactorrheaHypogalactiaPuerperal sepsis

Page 36: Copyright © 2012 by Mosby, an imprint of Elsevier Inc. PREGNANCY, CHILDBIRTH, AND THE PUERPERIUM Chapter Seven.

36Copyright © 2012 by Mosby, an imprint of Elsevier Inc.

CM Guideline Alert

15.k. Puerperal Sepsis Code O85, Puerperal sepsis, should be assigned with a

secondary code to identify the causal organism (e.g. for a bacterial infection, assign a code from category B95-B97, Bacterial infections in conditions classified elsewhere). A code from category A40, Streptococcal sepsis, or A41, Other sepsis, should not be used for puerperal sepsis. If applicable , use additional codes to identify severe sepsis (R65.2-) and any associated acute organ dysfunction. Needs additional code for causal organism.

Page 37: Copyright © 2012 by Mosby, an imprint of Elsevier Inc. PREGNANCY, CHILDBIRTH, AND THE PUERPERIUM Chapter Seven.

37Copyright © 2012 by Mosby, an imprint of Elsevier Inc.

Word Parts

chori/o = chorion

-carcinoma = cancer of epithelial

origin

Malignant Neoplasms (C58)Choriocarcinoma

Page 38: Copyright © 2012 by Mosby, an imprint of Elsevier Inc. PREGNANCY, CHILDBIRTH, AND THE PUERPERIUM Chapter Seven.

38Copyright © 2012 by Mosby, an imprint of Elsevier Inc.

Review Question

Which term describes a condition of deficient amniotic fluid?

A. chorioamnionitisB. oligohydramniosC. polyhydramniosD. erythroblastosis fetalis

Page 39: Copyright © 2012 by Mosby, an imprint of Elsevier Inc. PREGNANCY, CHILDBIRTH, AND THE PUERPERIUM Chapter Seven.

39Copyright © 2012 by Mosby, an imprint of Elsevier Inc.

Prenatal Diagnosis

Alpha fetoprotein (AFP) testContraction stress test (CST)Nonstress test (NST)Pregnancy test

Page 40: Copyright © 2012 by Mosby, an imprint of Elsevier Inc. PREGNANCY, CHILDBIRTH, AND THE PUERPERIUM Chapter Seven.

40Copyright © 2012 by Mosby, an imprint of Elsevier Inc.

Word Parts

amni/o = amnion

-centesis = surgical puncture

chorion/o = chorion

pelv/i = pelvis

-metry = measuring

Prenatal DiagnosisAmniocentesisChorionic villus sampling (CVS)Pelvimetry

Amniocentesis

Page 41: Copyright © 2012 by Mosby, an imprint of Elsevier Inc. PREGNANCY, CHILDBIRTH, AND THE PUERPERIUM Chapter Seven.

41Copyright © 2012 by Mosby, an imprint of Elsevier Inc.

Pregnancy and Delivery

Cerclage

Page 42: Copyright © 2012 by Mosby, an imprint of Elsevier Inc. PREGNANCY, CHILDBIRTH, AND THE PUERPERIUM Chapter Seven.

42Copyright © 2012 by Mosby, an imprint of Elsevier Inc.

Pregnancy and Delivery

Cesarean section (C-section, CS)

Page 43: Copyright © 2012 by Mosby, an imprint of Elsevier Inc. PREGNANCY, CHILDBIRTH, AND THE PUERPERIUM Chapter Seven.

43Copyright © 2012 by Mosby, an imprint of Elsevier Inc.

Word Parts

cephal/o = head

-ic = pertaining to

version = turning

episi/o = vulva

-tomy = cutting

vagin/o = vagina

-al = pertaining to

Pregnancy and Delivery ProceduresCephalic versionEpisiotomyVBAC (vaginal birth after C-section)Vaginal delivery

Presentation Assistance PCS:

delivery = extractionEpisiotomy

Page 44: Copyright © 2012 by Mosby, an imprint of Elsevier Inc. PREGNANCY, CHILDBIRTH, AND THE PUERPERIUM Chapter Seven.

44Copyright © 2012 by Mosby, an imprint of Elsevier Inc.

PCS Guideline Alert

C1 Procedures performed on products of conception are

coded to the Obstetrics section. Procedures performed on the pregnant female other than the products of conception are coded to the appropriate root operation in the Medical and Surgical section.

Page 45: Copyright © 2012 by Mosby, an imprint of Elsevier Inc. PREGNANCY, CHILDBIRTH, AND THE PUERPERIUM Chapter Seven.

45Copyright © 2012 by Mosby, an imprint of Elsevier Inc.

PCS Guideline Alert

C2 Procedures performed following a delivery or abortion

for curettage of the endometrium or evacuation of retained products of conception are all coded in the Obstetrics section, to the root operation Extraction and the body part Products of Conception, Retained. Diagnostic or therapeutic dilation and curettage performed during times other than the postpartum or post-abortion period are all coded in the Medical and Surgical section, to the root operation Extraction and the body part Endometrium.

Page 46: Copyright © 2012 by Mosby, an imprint of Elsevier Inc. PREGNANCY, CHILDBIRTH, AND THE PUERPERIUM Chapter Seven.

46Copyright © 2012 by Mosby, an imprint of Elsevier Inc.

Suffixes and Root Operations for Pregnancy, Childbirth, and the Puerperium

Page 47: Copyright © 2012 by Mosby, an imprint of Elsevier Inc. PREGNANCY, CHILDBIRTH, AND THE PUERPERIUM Chapter Seven.

47Copyright © 2012 by Mosby, an imprint of Elsevier Inc.

Review Question

Which term describes a procedure to turn the head of the fetus towards the cervical outlet for a vaginal delivery?

A. CSB. cerclageC. cephalic versionD. CVS

Page 48: Copyright © 2012 by Mosby, an imprint of Elsevier Inc. PREGNANCY, CHILDBIRTH, AND THE PUERPERIUM Chapter Seven.

48Copyright © 2012 by Mosby, an imprint of Elsevier Inc.

Sort these terms into their correct categories

Terms1. chorioamnionitis2. agalactia3. cerclage4. amniocentesis5. parturition

Categories__ A + P__ Pathology__ Procedures