Ob-Gyn Coding Alert

Question: My ob-gyn admitted a 27-year-old woman through the ED. She had chest pain due to peripartum cardiomyopathy with ejection fraction of 21% and congestive heart failure. The patient is approximately 2 to 3 months postpartum. When she was pregnant, she suffered dyspnea, edema of the lower extremities and episodes of near syncope. The symptoms worsened following delivery. Although the patient took ACE inhibitors and beta blockers for cardiac protection, she had to have surgery for the implantation of a dual-chamber defibrillator. What ICD-9 codes should I report for the admission?

Ohio Subscriber

Answer: For your primary diagnosis, you should report 674.54 (Peripartum cardiomyopathy, postpartum condition or complication). A "peripartum period" means the last month of the pregnancy to five months postpartum.

You should also report 648.64 (Other cardiovascular diseases, postpartum condition or complication) and 428.0 (Congestive heart failure, unspecified).

Remember: The Official Guidelines for Coding and Reporting state, "Chapter 11 codes have sequencing priority over codes from other chapters. Additional codes from other chapters may be used in conjunction with chapter 11 codes to further specify conditions."