Wiki MVA with 8 month gestation.

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pmaho

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A patient was 8 months pregnant w/twins who suffered a severe head-on MVA. The obstetric team emergently performed a laparotomy, splenectomy and delivered the deceased twins. The orthopaedic team then proceeded to treat multiple fractures.
I am looking for an appropriate ICD code for the mother's condition relating to the pregnancy and loss of the twins.

Patrick
 
Treating the pregnancy?

What a tragic case!

If you are only treating the fractures, I would code only the fractures.

From your scenario, by the time ortho was involved the patient was no longer pregnant.

Just my opinion.

F Tessa Bartels, CPC, CEMC
 
Yes, I agree with your opinion, the fracture treatment is the only procedures that I am coding, and perhaps, may not be incorrect coding to omit her condition. But if an ICD was to be used for her condition, what code would be appropriate?

Patrick CPC, COSC
 
I would not code

I would not code the diagnosis for her "condition" other than the fracture being treated and the cause (MVA).

You are not treating the pregnancy, or the internal injuries. Code only what you are treating.

Just my position on the case.

F Tessa Bartels, CPC, CEMC
 
I agree that the patient was not pregnant when the orthopedic surgery occurred, but....

It is my opinion that since the orthopedic repairs were dependent upon the decision from the trauma and obstetric teams that the patient was stable enough to undergo the additional surgery, the other injuries did play a role in the management of the patient by the orthopedic surgeons. In this case, the patient went emergently to the OR for splenectomy and repair of the traumatic uterine rupture. Immediately following closure of the abdomen, the orthopedic team stepped in to do their surgery. The patient did not leave the OR and remained under anesthesia for the entire time.

The orthopedic surgeon was very clear in his documentation that the injuries which had been treated by the surgical teams in the room ahead of him played a significant role in his management of the patient.
 
One piece of information that was not included in my above post:

The orthopedic surgeons not only did fracture fixation of the long bones, they also had to reduce a dislocation of the pubic symphysis. Does that influence how you would code the situation?
 
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