# diagnosis for cephalohematoma - Does anyone know



## LLcoder (Sep 1, 2010)

Does anyone know if the dx 767.19 would be appropriate to use for a 22 month old patient?  I do not see any age specifications for this dx code, but some nursing staff is having probs, saying this dx is saying it cannot be used for the patient?... Is anyone else aware of age specifications for 767.19?


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## JulesofColorado (Sep 1, 2010)

767.19 is Other Injuries to scalp due to birth trauma, so if this isn't due to a birth trauma then it isn't appropriate to use, I would look at 920 Contusion of face/scalp/neck except eye.

Please see below 

Birth trauma injuries to scalp Coding Clinic, Fourth Quarter 2003 Page: 69 to 70 Effective with discharges: October 1, 2003  


Birth Trauma Injuries to Scalp 

Effective October 1, 2003, code 767.1, Birth trauma, Injuries to scalp, has been expanded to uniquely identify epicranial subaponeurotic hemorrhage (subgaleal hemorrhage). Prior to this change, code 767.1 grouped together caput succedaneum, cephalhematoma, and chignon, in addition to massive epicranial subaponeurotic hemorrhage or subgaleal hemorrhage (SGH). SGH is a relatively rare event associated with high rates of newborn mortality and morbidity. The other conditions under 767.1 have no associated mortality or morbidity and are commonly seen after normal spontaneous vaginal delivery or uncomplicated forceps or vacuum extraction deliveries. 

The creation of a unique code for epicranial subaponeurotic hemorrhage will assist in collecting outcomes data associated with programs to decrease the incidence of this injury. As the number of vacuum extraction deliveries increases, the frequency of this injury has also increased. 

The United States Food and Drug Administration (FDA) issued a public health advisory in 1998 regarding the need for caution when using vacuum assisted delivery devices. Two of the major life-threatening complications associated with the use of vacuum assisted devices were subgaleal hemorrhage and intracranial hemorrhage (subdural, subarachnoid, intraventricular, or intraparenchymal hemorrhage). 

Subgaleal hemorrhage occurs when blood accumulates in the space between the galea aponeurotica (epicranial aponeurosis) and the periosteum of the skull (pericranium) resulting from damage to the emissary veins. Signs of subgaleal hemorrhage may be present at delivery or become apparent several hours or a few days following delivery. 


767 Birth trauma 

767.1 Injuries to scalp 
Delete          *Caput succedaneum 
*Cephalhematoma 
*Chignon (from vacuum extraction) 
*Massive epicranial subaponeurotic 
hemorrhage 

New code      767.11 Epicranial subaponeurotic hemorrhage  
 (massive) 
 Subgaleal hemorrhage 

New code      767.19 Other injuries to scalp  
 Caput succedaneum 
 Cephalhematoma 
 Chignon (from vacuum extraction)


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## preserene (Sep 2, 2010)

As for my openion , the cause for cephalhematoma is birh trauma, (apart from instrumental)meaning, the trauma caused by the very process of labor, when the fetus undergoes moulding and descent into the pelvic cavity during the various events of labor mechanism, even in spontaneous vaginal delivery. Every fetus passing through pelvis, is proned for this.This happens most frequently in first born children. Most of them undergo spontaneous resolution.
In the great majority of cases, cephalhematoma most probably commences during birth, and increases to a palpable tumor soon afterwards. But instances do occur, in which the swelling is not perceptible till several days after birth; and there is nothing against the opinion, that it may form on the skull subsequently to the birth of the child. *Its duration may extend over three or four months, or more.*.

ICD 9 code 920, 767.19 are the more appropriate codes for a recent one/on going event.

At a later date: late effect codes like 677, V codes like 13.7, V29.1; if was instrumental 958.8, 669.5 can be given a look.

Some may persist long due to calcification even infection, form sepsis or abcess. 
What is the presenting symptom/sign?
We have to know what is the reason for encounter-Presenting symptoms,signs, sequlae, at this time to the OV- may be it is indurated, infected or calcified or any other neurological / intracranial manifestations. This has to be given priority and first listed. 
If no symptom or sign associated with cephalhematoma, this can be only a secondary diagnosis or Vcode (History of code).

 But if they had come for follow up like concern, cosmetic purposes, with out active symptoms, follow up codes are also to be assigned 


Follow up should be considered for cases below 2years of age since the cranium continues to grow and there appears to be a chance for spontaneous resolution. Diagnostic x ray , CT / MRI may be needed.

Given rarity of calcified  cephalhematoma(CH), it is difficult to withdraw any conclusion regarding their clinical management. Nevethless, follow up for asymptomatic calcified CHs for atleast  a few months in the hope that they could disappear spontaneously with out any cosmetic problem.


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