This page addresses follow-up questions and additional information pertinent to our webinar
Obstetrical and Newborn Coding.
** The coding information and guidance are valid at the time of publishing. Learners are encouraged to research
subsequent official guidance in the areas associated with the topic as they can change rapidly.
Q: What is isoimmunization? How can you tell the difference between isoimmunization and prophylactic care?
A: Isoimmunization occurs when the mother’s blood type does not have antibodies that the baby has. In isoimmunization, the mother’s immune system recognizes the baby’s antibodies as foreign invaders and seeks to destroy them. This can cause serious complications with the pregnancy, including miscarriage. Isoimmunization can be prevented by administering Rhogam, which introduces the foreign antibodies to the mother’s system to prevent an immune reaction. When the patient is asymptomatic and Rhogam is administered, it is considered prophylactic care.
Q: For an infant born with a congenital anomaly, such as craniosynostosis, who has a family member who was born with the same condition, should code Z82.79, Family history of other congenital malformations, deformations, and chromosomal abnormalities, also be reported?
A: Code Z82.79, Family history of other congenital malformations, deformations, and chromosomal abnormalities, is an optional code that may be reported in addition to codes for chromosomal anomalies on the baby’s record. If genetic testing is performed, this code should be added to help establish medical necessity.
Q: When there is a discrepancy in the chart, such as a patient with several notes indicating the patient had a primary cesarean section and then a note stating it was a repeat cesarean section, should the doctor be queried for clarification?
A: The textbook answer to this is yes; whenever there is a discrepancy in chart documentation, the provider should be queried. However, there are times when the discrepancy is an obvious error and probably an issue with a template. In the real world, preventing query fatigue among providers is a significant consideration. The coder should use his/her best judgment and query when the record documentation is unclear, and it cannot be determined which documentation element is correct.
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Kristi Pollard, RHIT, CCS, CPC, CIRCC, AHIMA-Approved ICD-10-CM/PCS Trainer
Director of Coding Quality & Education
Kristi is the Director of Coding Quality & Education with more than 25 years of industry experience; she is responsible for the development of web-based, instructor-led, and webinar training materials; conducting training in ICD-10-CM/PCS and CPT; and performing DRG and APC audits. Kristi has an extensive background in coding education and consulting and is a national speaker and published writer on topics related to ICD-10 and CPT coding and code-based reimbursement. She has designed and developed training programs for inpatient and outpatient hospital-based coding, with a focus on vascular interventional radiology, interventional cardiology, orthopedics, and obstetrics.