Wiki Post-surgical anemia - Patient presents to clinic

[erjones147]

Patient presents to clinic for a follow-up after having had hospitalization to remove "retained products of conception (demised fetus)."

Our provider codes 285.9 (among other codes) and narrates "post-surgical anemia."

I'm considering using any or all of the following for the anemia and would appreciate some guidance:

V67.00
639.8
998.9

In general, I'm having trouble distinguishing between a surgery to remove an already demised fetus and coding for a complication of abortion, but 285.9 just doesn't sound right. Relevant portions of the HPI follow, which had to have been based on some sort of op report that was not a discharge summary:

She comes in following hospitalization on 9/30 for surgical
removal of retained products of conception..... Her appointment with
Dr. X was on 9/23 at which time she had a scan performed and the fetus was
found to be demised. She estimated the length of demise was approximately 4-6 weeks. The baby was found hunched over with no amniotic fluid surrounding it. Due to the length of time the baby was demised and vascularity of the placenta the patient needed to be ruled out for DIC and D&E was planned............

 

[mitchellde]

The big question is does the patient have post op anemia? If so it should be coded with a surgical complication code first and the anemia code second. Also if the visit is within the global of a procedure your physician performed, the visit is non billable unless it is a return to the OR.

 

[erjones147]

1) Which surgical complication code, though? The one for obstetric surgery or the one following abortion (they exclude each other)? And would I then still use 285.9 after the complication codes?

2) This was just a clinic follow-up following a separate hospital visit. None of our providers were involved in the original visit