# 2 degree perineal lacreation during vaginal delivery



## farheenkirmani (Feb 18, 2014)

in this case patient admitted with normal full term pregnancy with active abour without any complication.then having 2 degree perineal lacreation what will be correct coding only 664.12.no need to code 650.please guide


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## bonzaibex (Feb 18, 2014)

664.12 isn't a valid code.  The 5th digit choices for 664.1X are [0, 1, 4] only.  

The note under 650 states "This code is for use as a single diagnosis code and is not to be used with any other code in the range 630-676." So no, you do NOT code the 650.


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## farheenkirmani (Feb 18, 2014)

Thanx for the reply


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## SHERRYDUDLEY (Feb 18, 2014)

*I disagree*

My opinion is a "normal" delivery (dx 650) includes a 1st or 2nd degree lac. You would not bill separate for it.


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## bonzaibex (Feb 19, 2014)

I agree, you wouldn't bill separately for the lac repair.  But your dx code should reflect the tear.


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## farheenkirmani (Feb 20, 2014)

*Clarify*

Do clarify do we need to write 650 along with tear code or not


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## bonzaibex (Feb 20, 2014)

No, you do not use the 650 ICD-9 code if you are also using the ICD-9 code for the tear.


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## SHERRYDUDLEY (Feb 20, 2014)

*Again, I disagree*

If a 1st or 2nd degree tear is inclusive to code 650 then 650 is the only necessary code. You would only need an additional code if it was a 3rd or 4th degree lac and you were applying the modifier 22 to get extra reimbursement.  
My advice.... call the AMA for clarification. 

Sherry


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## areeder (Feb 25, 2014)

I am not sure I am following you all, the 650 code does NOT include tears/lacerations. The 650 code states "delivery requiring minimal or no assistance, with or without episiotomy (which is not the same as a laceration or a tear, this is a "cut" done by the doctor)"...
the codes for a first degree tear/laceration is 664.0X; perineal laceration, rupture or tear involving fourchette, hymen, labia, skin, vagina, vulva
second degree tear/laceration is 664.1X; perineal laceration, rupture or tear (following episiotomy) involving pelvic floor, perineal muscles, vaginal muscles. 
I hope this helps but if i am off track, pls let me know. Thanks!


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## SHERRYDUDLEY (Feb 27, 2014)

*Response*

Ok, let me clarify my "opinion".....

59400 with dx 650 is a standard normal delivery...which by most carrier standards include a 1st or 2nd degree lac. 

SO...if the lac did not affect the pregnancy, delivery or pp care and does not allow additional reimbursement and is considered inclusive by the ins. carriers there is no need to include the dx code on the claim. 

In my opinion it's the same thing as the artificial rupture of membranes....IT'S INCLUSIVE TO THE DELIVERY. Yes it should be documented in the pt's chart that is was done BUT if it DOES NOT influence how the claim is paid there is no reason for it to be needed on the actual claim.  

AGAIN, I STRESS...this is my opinion. The AMA is a wonderful source of information! I have actually faxed them op-reports (without pt's info of course) when I have been in doubt of using an unlisted code vs a code with a reduced service modifier. Also, if there is ever an audit you have documentation in support of your coding.


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## KPriceAZ08 (Mar 11, 2014)

Check out page 15 of the ICD-9 coding guidelines.  Under Normal Delivery, Code 650.  It mentions "Code 650 is always a principal diagnosis.  It is not to be used if any other code from chapter 11 is needed to describe a current complication of the antenatal, delivery, or perinatal period."


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