Preterm Labor = Preterm Labor…Or Does It?

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Cathie Wilde, RHIA, CCS, Vice President of Coding Services

Cathie Wilde, RHIA, CCS, Vice President of Coding Services

A twenty-five year old woman who is 34 weeks pregnant is admitted for mild pre-eclampsia. Treatment for pre-eclampsia is successful but during course of the admission the patient develops other pregnancy complications including thrombocytopenia, oligohydramnios and painful diastasis recti. Determination is made that for the safety of the patient and the baby, delivery must take place. The patient is induced with Cervidil and the baby is delivered at 35 weeks. The physician lists preterm labor as one of the discharge diagnoses.

Here are my thoughts…

Since Mom delivered at 35 weeks, is it appropriate to code 644.21, Early onset of delivery, delivered with or without mention of antepartum condition?

According to Coding Clinic 3rd Quarter 2011, p. 3 it would not be appropriate to assign 644.21 as an additional code because the labor was induced. The coding advice was further clarified and confirmed with the recent 2nd Quarter 2013 Coding Clinic, p. 27 that pre-term labor code 644.2x is to be used only to describe spontaneous early labor.

What are your thoughts?

One Response to “Preterm Labor = Preterm Labor…Or Does It?”

  • Teodora Ucenic says:

    1. If a condition necessitate therapeutic treatment must be listed as sec. Dx. Hence if there is any specific treatment like Betamethasone, Mg Sulphate or any other given for prematurity, the condition must be coded. Additionaly, pretermaturity increase the rate of induction insuccess, surgical risk and increase nursing care and lenght of stay.
    2. In the ICD 9 CM manual under 644.21 it is stated: Onset (spontaneous) of delivery; premature labour with onset of delivery.
    Mind you that spontaneous is between brackets and in the same manual is stated: “ () parentheses are used in both index and tabular to enclose supplementary words that may be present or absent in the statement of a disease or procedure without affecting the code number to which it is assigned. The terms within the parenthesis are referred to as nonessential modifiers.”

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