EmailAdhesions due to previous surgery in a LUSCS
Publication Date: May 2022
Implementation Date: 1/06/2022
ICD 10 AM Edition: Eleventh Edition
Query Number: 3741
Coding Rule Q3423 Adhesions divided during caesarean section without labour directs coders to assign O65.5 Labour and deliver affected by abnormality of maternal pelvic organs where pelvic / peritoneal adhesions are divided during caesarean section.
ACS 1521 Conditions and injuries in pregnancy, nonobstetric conditions complicating pregnancy states that conditions classified to Chapter 19 Injury, poisoning and certain other consequences of external causes are never assigned a code from Chapter 15. Does this also apply to complication codes that are included under the relevant body system such N99.4 Postprocedural pelvic peritoneal adhesions and K91.89 Other intraoperative and postprocedural disorders of digestive system, not elsewhere classified e.g for adhesions due to previous surgery in an admission for LUSCS?
Where pelvic peritoneal adhesions are due to previous surgery, is it correct to assign O65.5 Labour and deliver affected by abnormality of maternal pelvic organs and N99.4 Postprocedural pelvic peritoneal adhesions?
For adhesions due to previous surgery not specified as ‘pelvic peritoneal’ is it correct to assign O65.5 Labour and deliver affected by abnormality of maternal pelvic organs, K91.89 Other intraoperative and postprocedural disorders of digestive system, not elsewhere classified and K66.0 Peritoneal adhesions (as ACS 1904 Procedural Complications states that an additional code from Chapters 1 to 19 may be assigned where it provides further specificity)?
Search Details
Coding Rule Q3423 Adhesions divided during caesarean section without labour -
Published: 16 December 2019
Question
What ICD-10-AM code is assigned for pelvic adhesions, divided during caesarean section?
Answer
The ICD-10-AM Alphabetic Index below is inconsistent with other index entries for O65.5 Labour and deliver affected by abnormality of maternal pelvic organs that specify conditions complicating ‘labour or delivery’:
Adhesions, adhesive (postinfective)
- pelvic, pelvis (see also Adhesions/peritoneum)
- peritoneum, peritoneal (male)
- - female pelvic (postpartal) (to uterus)
- - - affecting
- - - - labour and delivery O65.5
- - - - pregnancy O34.8
Classification guidelines in ACS 1506 Fetal presentation, disproportion and abnormality of maternal pelvic organs should specify that codes in category O64–O66 may be assigned ‘during labour and/or delivery’.
Therefore, assign O65.5 Labour and delivery affected by abnormality of maternal pelvic organs where division of adhesions are required during caesarean section, regardless of when the adhesions are first diagnosed.
ACS 1506 Fetal presentation, disproportion and abnormality of maternal pelvic organs and the inconsistent index entry were amended in Eleventh Edition Errata 3.
For implementation 1 January 2020.
VICC # 3320 Female adhesions
Published: 2017-18 March Database
Question
If adhesions are documented in the peritoneum of a female patient without the word "pelvis" documented, can we use our clinical knowledge of the information provided to assign N73.6? Or without the wording of "pelvis" do we default to the code K66.0 - peritoneal adhesions, even though the female pelvis is an exclusion?
Answer
VICC research indicates that the peritoneum is the membrane that lines the walls of the abdominal and pelvic cavities and viscera, therefore there is abdominal and pelvic peritoneum.
A female patient should not be assumed to have pelvic peritoneal adhesions without documentation of ‘pelvis’ or of a site that specifically leads to the female pelvic code in the Index, e.g. uterus.
The Index at Adhesions/peritoneal, peritoneum (male) provides a default to K66.0 Peritoneal adhesions. The term ‘female pelvic’ is an essential modifier at the Index at Adhesions/peritoneal, peritoneum/female pelvic, indicating that ‘pelvic’ must be documented before this entry can be followed.
For implementation 1 April 2018.
ACS 1521 Conditions and injuries in pregnancy, nonobstetric conditions complicating pregnancy states that conditions classified to Chapter 19 Injury, poisoning and certain other consequences of external causes are never assigned a code from Chapter 15. Does this also apply to complication codes that are included under the relevant body system such N99.4 Postprocedural pelvic peritoneal adhesions and K91.89 Other intraoperative and postprocedural disorders of digestive system, not elsewhere classified e.g for adhesions due to previous surgery in an admission for LUSCS?
Where pelvic peritoneal adhesions are due to previous surgery, is it correct to assign O65.5 Labour and deliver affected by abnormality of maternal pelvic organs and N99.4 Postprocedural pelvic peritoneal adhesions?
For adhesions due to previous surgery not specified as ‘pelvic peritoneal’ is it correct to assign O65.5 Labour and deliver affected by abnormality of maternal pelvic organs, K91.89 Other intraoperative and postprocedural disorders of digestive system, not elsewhere classified and K66.0 Peritoneal adhesions (as ACS 1904 Procedural Complications states that an additional code from Chapters 1 to 19 may be assigned where it provides further specificity)?
Search Details
Coding Rule Q3423 Adhesions divided during caesarean section without labour -
Published: 16 December 2019
Question
What ICD-10-AM code is assigned for pelvic adhesions, divided during caesarean section?
Answer
The ICD-10-AM Alphabetic Index below is inconsistent with other index entries for O65.5 Labour and deliver affected by abnormality of maternal pelvic organs that specify conditions complicating ‘labour or delivery’:
Adhesions, adhesive (postinfective)
- pelvic, pelvis (see also Adhesions/peritoneum)
- peritoneum, peritoneal (male)
- - female pelvic (postpartal) (to uterus)
- - - affecting
- - - - labour and delivery O65.5
- - - - pregnancy O34.8
Classification guidelines in ACS 1506 Fetal presentation, disproportion and abnormality of maternal pelvic organs should specify that codes in category O64–O66 may be assigned ‘during labour and/or delivery’.
Therefore, assign O65.5 Labour and delivery affected by abnormality of maternal pelvic organs where division of adhesions are required during caesarean section, regardless of when the adhesions are first diagnosed.
ACS 1506 Fetal presentation, disproportion and abnormality of maternal pelvic organs and the inconsistent index entry were amended in Eleventh Edition Errata 3.
For implementation 1 January 2020.
VICC # 3320 Female adhesions
Published: 2017-18 March Database
Question
If adhesions are documented in the peritoneum of a female patient without the word "pelvis" documented, can we use our clinical knowledge of the information provided to assign N73.6? Or without the wording of "pelvis" do we default to the code K66.0 - peritoneal adhesions, even though the female pelvis is an exclusion?
Answer
VICC research indicates that the peritoneum is the membrane that lines the walls of the abdominal and pelvic cavities and viscera, therefore there is abdominal and pelvic peritoneum.
A female patient should not be assumed to have pelvic peritoneal adhesions without documentation of ‘pelvis’ or of a site that specifically leads to the female pelvic code in the Index, e.g. uterus.
The Index at Adhesions/peritoneal, peritoneum (male) provides a default to K66.0 Peritoneal adhesions. The term ‘female pelvic’ is an essential modifier at the Index at Adhesions/peritoneal, peritoneum/female pelvic, indicating that ‘pelvic’ must be documented before this entry can be followed.
For implementation 1 April 2018.
Response
VICC notes that IHPA Coding Rule Q3423 Adhesions divided during caesarean section without labour has been superseded by IHPA Coding Rule Q3685 Adhesions divided during caesarean section without labour published 15 June 2021 for implementation 1 July 2021.
ACS 1521 Conditions and injuries in pregnancy classification section, dot point two and IHPA Coding Rule Q3685 instructs clinical coders to assign as an additional diagnosis a code to add specificity to the Chapter 15 code.
For documentation of 'pelvic peritoneal adhesions due to previous surgery’ VICC agrees with the enquirer's suggestions to assign O65.5 Labour and delivery affected by abnormality of maternal pelvic organs and N99.4 Postprocedural pelvic peritoneal adhesions. Follow Index entries Adhesions, adhesive (postinfective)/pelvic, pelvis (see also Adhesions/peritoneum)/ peritoneum, peritoneal (male)/female pelvic (postpartal) (to uterus)/affecting/labour or delivery and Adhesions, adhesive (postinfective)/postprocedural peritoneal NEC/pelvic.
For documentation of 'adhesions due to previous surgery not specified as ‘pelvic peritoneal’, assign O65.5 Labour and delivery affected by abnormality of maternal pelvic organs, K91.89 Other intraoperative and postprocedural disorders of digestive system, not elsewhere classified and K66.0 Peritoneal adhesions. Follow Index entries Adhesions, adhesive (postinfective)/pelvic, pelvis (see also Adhesions/peritoneum)/ peritoneum, peritoneal (male)/female pelvic (postpartal) (to uterus)/affecting/labour or delivery; Adhesions, adhesive (postinfective)/postprocedural/peritoneal NEC and Adhesions, adhesive (postinfective).
VICC interprets the statement in ACS 1521 which states 'Nonobstetric injuries/poisonings (conditions classified to Chapter 19 Injury, poisoning and certain other consequences of external causes) are never assigned a code from Chapter 15 Pregnancy, childbirth and the puerperium.' to mean that conditions that are not classified to a code in Chapter 15 such as injuries, poisonings, trauma and some complications, e.g. difficult intubation, are not assigned a code from Chapter 15. See also ACS 1904 Procedural complications, example 21. The statement does not preclude an additional diagnosis code from another chapter being assigned to add specificity to the Chapter 15 code as is the case in these scenarios.
ACS 1521 Conditions and injuries in pregnancy classification section, dot point two and IHPA Coding Rule Q3685 instructs clinical coders to assign as an additional diagnosis a code to add specificity to the Chapter 15 code.
For documentation of 'pelvic peritoneal adhesions due to previous surgery’ VICC agrees with the enquirer's suggestions to assign O65.5 Labour and delivery affected by abnormality of maternal pelvic organs and N99.4 Postprocedural pelvic peritoneal adhesions. Follow Index entries Adhesions, adhesive (postinfective)/pelvic, pelvis (see also Adhesions/peritoneum)/ peritoneum, peritoneal (male)/female pelvic (postpartal) (to uterus)/affecting/labour or delivery and Adhesions, adhesive (postinfective)/postprocedural peritoneal NEC/pelvic.
For documentation of 'adhesions due to previous surgery not specified as ‘pelvic peritoneal’, assign O65.5 Labour and delivery affected by abnormality of maternal pelvic organs, K91.89 Other intraoperative and postprocedural disorders of digestive system, not elsewhere classified and K66.0 Peritoneal adhesions. Follow Index entries Adhesions, adhesive (postinfective)/pelvic, pelvis (see also Adhesions/peritoneum)/ peritoneum, peritoneal (male)/female pelvic (postpartal) (to uterus)/affecting/labour or delivery; Adhesions, adhesive (postinfective)/postprocedural/peritoneal NEC and Adhesions, adhesive (postinfective).
VICC interprets the statement in ACS 1521 which states 'Nonobstetric injuries/poisonings (conditions classified to Chapter 19 Injury, poisoning and certain other consequences of external causes) are never assigned a code from Chapter 15 Pregnancy, childbirth and the puerperium.' to mean that conditions that are not classified to a code in Chapter 15 such as injuries, poisonings, trauma and some complications, e.g. difficult intubation, are not assigned a code from Chapter 15. See also ACS 1904 Procedural complications, example 21. The statement does not preclude an additional diagnosis code from another chapter being assigned to add specificity to the Chapter 15 code as is the case in these scenarios.
