How to Conquer the Challenges of Teaching Obstetrics in Medical Coding

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As the aging population in America continues to grow, the need for health care and professional medical coders will continue to increase significantly. The scope and complexity of the transition to ICD-10-CM/PCS by healthcare providers in the United States is significant. The conversion to a modified version of the classification system already in use by the rest of the world will be a transformational effort in the U.S. affecting many systems, processes, and people. It will have a tremendous and widespread impact on every operational process across healthcare. Employers desire a well-trained workforce to ensure accuracy and to maximize revenue. ICD-10 CM/PCS implementation is generating a flurry of excitement in conjunction with an overall uneasiness about how prepare and adapt to the new system. This post is the first in a series from industry expert and award-winning author, Lorraine Papazian-Boyce, on some of the most complex medical specialties.  To learn more from Lorraine Papazian-Boyce, sign up for one of her upcoming webinars here!

Obstetrics is one the most challenging coding topics for instructors to teach and for students to learn. The task is multiplied when all codes sets—ICD-10-CM, ICD-10-PCS, ICD-9-CM, and CPT— are considered. There is little overlap among the coding guidelines and the guidelines are sometimes opposite for various code sets.

Challenges in diagnostic coding (ICD-10-CM, ICD-9-CM) include:

  • Each phase of pregnancy must be considered separately.
  • Pre-existing conditions are coded differently than obstetric-related conditions.
  • Multiple codes are often required.
  • Multiple diagnoses must be sequenced correctly for the current encounter.
  • Fifth digits (ICD-9-CM) and fifth-, sixth, and seventh characters (ICD-10-CM) must be assigned accurately for the current encounter.
  • Indexing of obstetric conditions can be confusing to navigate.
  • V-codes (ICD-9-CM) and Z-codes (ICD-10-CM) are required for all deliveries and many pregnancy encounters.
  • Coders must distinguish between conditions of the mother and those of the infant.

Challenges in procedure coding include:

  • Bundled or packaged services must be identified.
  • Obstetric history, such as past cesarean deliveries, can affect coding for the current delivery (CPT).
  • Services provided by distinct physicians must be separated out (CPT).
  • Not all obstetric services are coded from the obstetrics section.
  • Coders must distinguish between services for the mother and those for the infant.

Accurate obstetrics coding requires a consistent, methodical approach, which I address through the three skills of an “Ace coder:” abstracting, assigning, and arranging (sequencing) codes. When abstracting, students review the medical record with a list of questions specific to obstetric diagnoses and procedures. They must answer these questions before they begin coding the case. Examples of abstracting questions when coding ICD-10-CM are:

  • What trimester is the pregnancy?
  • How many weeks of gestation are completed?
  • How many pregnancies has the patient had, including the current one?

Examples of abstracting questions when coding CPT are:

  • Is a vaginal delivery attempted before cesarean delivery is performed?
  • Is more than one physician involved in the antepartum care, delivery, and postpartum care?

Examples of abstracting questions when coding ICD-10-PCS are:

  • Is the procedure performed on the products of conception?
  • Does the procedure assist a fetus, embryo, or unborn child pass through the genital canal?

Assigning codes involves using the Index and Tabular List to identify the code(s) for each condition or procedure, assigning all characters of the code, and following official guidelines and instructional notes in the coding manual. Diagnosis coding for obstetrics almost always requires multiple coding for the weeks of gestation during pregnancy and the outcome of delivery. In ICD-10-CM, an additional character is usually required to identify the trimester and, in case of multiple gestation pregnancies, to identify the fetus affected by a condition.

Arranging (sequencing) codes involves again following official guidelines and instructional notes to place the codes in the correct sequence. Sequencing of diagnosis codes requires correctly identifying the reason for the obstetrics encounter or the principal diagnosis for inpatient admissions, including identifying the main complication of labor and delivery and the main reason a cesarean delivery was performed. CPT coding requires correct sequencing when multiple procedures are performed and for multiple gestation deliveries.

To help you better understand how to apply these principles to obstetrics coding, Pearson is hosting a free webinar Teaching Obstetrics Across Code Sets: ICD-9-CM, ICD-10-CM, ICD-10-PCS, CPT on Tuesday, October 13, 2015 3:00 PM – 4:30 PM Eastern Time. We will take a sample obstetrics case and code it in all code sets: ICD-10-CM/PCS, ICD-9-CM, and CPT. AHIMA and AAPC CEUs are offered. Click here to register. Registration is required and free.

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About the Author

Lorraine M. Papazian-Boyce, MS, CPC

Lorraine M. Papazian-Boyce, MS, CPC

Lorraine M. Papazian-Boyce is an award-winning author and instructor. She has authored two Pearson titles, ICD-10-CM/PCS Coding: A Map for Success, which received the Most Promising New Textbook Award–2013 from the Textbook and Academic Authors Association. Her newest title, Pearson’s Comprehensive Medical Coding is receiving rave reviews–students and instructors alike value her approach and simplified methodology of abstracting, assigning, and arranging code sets. She was named Educator of the Year – Instruction – 2011 by Career Education Corporation (CEC). Lorraine also contributed to the development of Pearson’s online, comprehensive coding solution, MyHealthProfessionsLab for Medical Billing & Coding. This new solution can be used across your entire coding program and covers content from all code sets.
Lorraine has taught at several career colleges, both traditional and online. She has over 30 years of experience in healthcare administration as office manager; biller and coder; management consultant to hospitals, nursing homes, and physicians; and former owner of a medical billing and coding service. Lorraine has contributed to numerous textbooks and journals in the health professions field and is a nationally-known speaker. She holds a M.S. in Health Systems Management; the CPC credential; and is an AHIMA-Approved ICD-10-CM/PCS Trainer and Ambassador.