Inpatient coders are probably well-acquainted with ICD-9-CM procedures. However, ICD-10-PCS is completely different, and coders will need to adjust to it. Maternal fetal medicine (MFM) procedures highlight these differences and can serve as a foundation for understanding ICD-10-PCS.
Understand the MFM specialty
The Society of Maternal-Fetal Medicine defines an MFM specialist as an obstetrician/gynecologist who has completed two or three years of additional formal education and clinical experience within an American Board of Obstetrics and Gynecology (ABOG)-approved Maternal-Fetal Medicine Fellowship Program. This individual must be eligible for or certified by ABOG as having a special competence in the following:
- Diagnosis and treatment of women with complications of pregnancy
- Pre-existing medical conditions which may be affected by pregnancy
- Medical conditions that affect the pregnancy itself
MFM specialists possess the specific training and experience necessary to perform complex diagnostic and therapeutic procedures during pregnancy. These procedures can involve the fetus and/or the mother. Examples include targeted ultrasound or fetal intravascular transfusions. An MFM specialist requires advanced knowledge of the obstetrical, medical, genetic, and surgical complications of pregnancy as well as their effects on both the mother and fetus. They also need advanced knowledge of newborn adaptation.
This article will compare and contrast how to code a fetal thoracentesis using ICD-9-CM and ICD-10-CM/PCS.
Coding a fetal thoracentesis: ICD-9-CM and CPT
During a fetal thoracentesis, a physician drains and removes excess fluid from a fetus. Physicians may also perform the procedure to drain and remove multiple congenital cystic adenomatoid malformation (CCAM) cysts.
When the procedure is performed to remove CCAM cysts, coders currently report the following ICD-9-CM procedure codes, depending on the specific documentation provided:
- 75.35 (other diagnostic procedures on fetus and amnion)
- 75.36 (correction of fetal defect)
- 88.78 (diagnostic ultrasound of gravid uterus)
- 88.79 (other diagnostic ultrasound)
- 00.09 (other therapeutic ultrasound)
- 99.29 (injection or infusion of other therapeutic or prophylactic substance)
The appropriate ICD-9-CM diagnosis codes are:
- For the fetus: 778.0 (hydrops fetalis not due to isoimmunization), 748.4 (congenital cystic lung), and 779.89 (other specified conditions originating in the perinatal period)
- For the mother: 655.83 (other known or suspected fetal abnormality, affecting management of mother, not elsewhere classified)
For outpatient/professional coding, coders would report CPT code 59074 (fetal fluid drainage [e.g., vesicocentesis, thoracocentesis, paracentesis], including ultrasound guidance). Note that unlike ICD-9-CM, CPT bundles the ultrasound guidance into the procedure itself.
Coding a fetal thoracentesis: ICD-10-PCS
Consider the following case study:
Indications: This is a 22-year-old gravida 4, para 2-0-1-2 at 24 weeks gestation. Patient has a known fetal CCAM. Fetus has now developed massive non-immune hydrops secondary to the multi-cystic CCAM.
Procedure: Fetal thoracentesis with drainage of multiple CCAM cysts.
Diagnosis: 24-week single gestation, fetal hydrops, large multi-cystic right CCAM.
Specimens: Fetal fluid for karyotype.
Procedure note: Patient was taken to the OR, placed in the supine position, prepped, and draped in sterile fashion for the abdominal procedure. IV sedation was administered per anesthesia protocol. Under ultrasound guidance, a 20-gauge needle was advanced through the uterine wall into the fetal chest cavity. Color-flow Doppler was used to ensure absence of fetal blood vessels at the entry point into the fetus. Three cysts ranging from 1.5 – 2.5 cm were drained individually. Clear fluid was obtained from all cysts, and a total of approximately 35 cc were drained under continuous ultrasound guidance. No fetal bradycardia was observed. Procedure was terminated, and needles removed under ultrasound guidance. No evidence of fetal bleeding. Fetal heart rate was 140 at the conclusion of the procedure. Patient taken to a labor room for continued observation. Fetal fluid was sent for karyotype.
Ccoders must note that ICD-10-PCS defines a fetus as a product of conception. First, look up the term drainage, then product of conception in the Alphabetic Index. This directs coders to code category 1090.
The 1 denotes obstetrics
The 0 denotes pregnancy.
The 9 denotes drainag
The 0 denotes products of conception.
Next, determine the approach. A fetal thoracentesis requires a percutaneous approach, which means coders should assign 3 as the fifth character in the PCS code.
The sixth character denotes the device. In this case, there is no device. Thus, coders should assign Z.
Finally, assign a qualifier as the seventh character. In this case, the qualifier is other fetal fluid. Thus, coders should assign B.
The final ICD-10-PCS code is 10903ZB.
In addition to coding the fetal thoracentesis, coders must also report an ICD-10-PCS code for the intra-operative ultrasound procedure.
First, look up ultrasonography, then fetus, single, second trimester in the Alphabetic Index. This directs coders to ICD-10-PCS code BY4CZZZ.
Next, confirm this code by viewing the actual code table.
The B denotes imaging.
The Y denotes fetus and obstetrical.
The 4 denotes ultrasonography.
The C denotes second trimester single fetus.
There is no contrast or qualifiers, thus coders report a Z for the last three characters in this PCS code.
Thus, the code for this procedure is indeed BY4CZZZ, as indicated by ICD-10-PCS table BY4.
Coders must also report a code for the IV anesthesia sedative. First, look up the term administration in the Alphabetic Index. The index directs coders to the term introduction. Next, refer to the sub-term vein, then peripheral, then anesthetic, intracirculatory. This directs coders to code category 3E03.
The first 3 denotes administration.
The E denotes physiological systems
The 0 denotes introduction.
The second 3 denotes peripheral vein.
Next, we must assign the approach. This procedure requires a percutaneous approach, which means coders should assign a 3 as the fifth character.
Assign N as the sixth character to denote analgesics, hypnotics sedatives.
Assign Z as the seventh character to denote that there is no qualifier.
Thus, the final ICD-10-PCS code is 3E033NZ.
In summary, coders should report the following ICD-10-PCS codes for this case study:
- 10903ZB
- BY4CZZZ
- 3E033NZ
Coding a fetal thoracentesis in ICD-10-CM
In terms of ICD-10-CM diagnosis codes, coders must also report the fetal hydrops and CCAM.
Coders cannot report a congenital diagnosis code to denote CCAM in a fetus because the fetus is still within the antepartum care period.
Instead, look up the term maternal care, which directs coders to pregnancy, complicated by. Then locate the sub-term fetal problem, specified NEC. This directs coders to code category O36.89-. Look up this category in the Tabular List to complete the code.
Thus, the complete diagnosis code for fetal CCAM is O36.8921 (maternal care for other specified fetal problems).
To code fetal hydrops, look up the term maternal care, which directs coders to pregnancy, complicated by. Then locate the sub-term hydrops, fetalis. This directs coders to code category O36.2-. Look up this category in the Tabular List to complete the code.
Thus, the complete diagnosis code for fetal hydrops is O36.22X1 (maternal care for hydrops fetalis, second trimester, single gestation).
The case study addressed in this article indicates the complexity of coding pregnancy-related complications, such as fetal anomalies encountered during antepartum care. Coders must review documentation carefully so they understand how ICD-10-CM/PCS will capture the procedure itself, any associated procedures, and the diagnoses. Maternal fetal medicine presents many opportunities in ICD-10-CM/PCS to learn and understand the anatomy and physiology of the maternal patient and fetal medicine.
Editor’s note: Lori-Lynne A. Webb, CPC, CCS-P, CCP, CHDA COBGC, is an independent coding consultant located in Melba, ID. Webb is also an AHIMA ICD-10-CM/PCS-accredited trainer and an AHIMA ACE Mentor. You can reach her at Webb Services, (208) 965-0230 or at webbservices.lori@gmail.com.