Ob-Gyn Coding Alert

Question: I seem to recall at a recent conference I attended that the speaker said the fifth digit has to be the same for all diagnoses on a delivery. I have one today that has postpartum hemorrhage and a fetal heart anomaly. So the hemorrhage is 666.12, and the heart anomaly is 655.81. The 666.1x series cannot use 666.11 (and is not appropriate). The 655.8x series cannot use 655.82. Am I wrong with what I thought I heard?


Washington Subscriber

Answer: Unfortunately so.

ICD-9 rules read: -The fifth digits, which are appropriate for each code number, are listed in brackets under each code. The fifth digits on each code should all be consistent with each other. That is, should a delivery occur all of the fifth digits should indicate the delivery.- So, the fifth digits have to be compatible but not the same. 

In other words, you could not use a fifth digit of -3- (Antepartum condition or complication) with a fifth digit of -1- or -2- if the patient delivered during the hospitalization. However, you could use both a -1- and -2- for that hospitalization since the controlling word is -delivered.-