Pregnancy Coding- CM Codes. Code the following questions with the correct CM code 3. The

Pregnancy Coding- CM Codes. Code the following questions with the correct CM code 3. The patient is admitted to the hospital with excessive vaginal bleeding two days follow- ing an elective abortion at an outpatient surgical facility. The patient is immediately taken to surgery for a dilatation and curettage. The pathology report describes the tissue removed as “retained products of conception.” The previous elective abortion was not completed as expected. At the time of the procedure it was determined the patient had anemia due to the acute blood loss, and it was treated . The physician’s final diagnosis is “delayed hemorrhage following elective abortion, now completed, anemia of pregnancy due to acute blood loss” The patient is able to be discharged the next day. Principal Dx Secondary Dxs : 4. The patient was admitted from home on May 31 with vaginal bleeding. This is the patient’s third admission to labor and delivery during this pregnancy. The patient is 33 years old, gravida 1. para 0, with an estimated date of confinement of July 9. She has twin gestation (two placentae and two amniotic sacs) and complete placenta previa. Because of this last episode of bleeding it was decided to keep her at bed rest in labor and delivery at the hospital so that, should any further excessive bleeding occur, she would be available for emergency cesarean delivery if necessary. The intent was to keep her until she reached 36 weeks gestation as recommended by the perinatologist in consultation. On June 10 she had bright red bleeding from the vagina. There were contractions of preterm labor noted. Because she was one day short of 36 weeks gestation, it was decided to go forward with a primary low cervical cesarean delivery for the complete placenta previa with hemorrhage. She delivered a 4 pound, 9 ounce viable female with Apgars of 8 and 9 at 16:01 p.m. She delivered a 4 pound, 15 ounce viable male with Apgars of 7 and 9 at 16:02 p.m. Intraoperative blood loss was approximately 1 liter. She was anemic due to acute blood loss prior to surgery. She had a good recovery from the surgery and her hemoglobin stabi- lized at 8.2 gm. She was discharged home to follow up in the office in two weeks for an incision check. Her twin infants remained in the premature nursery for further treatment. Principal Dx: Secondary Dxs 5. HISTORY: The patient is a 28-year-old, gravida 2, para , with complete/total placenta previa with four bleeding episodes was admitted to the hospital. She has a previous cesarean section for her first child. The patient has received steroids and has consented for a repeat preterm cesarean delivery because of the placenta previa and the threat-to-life hemorrhage that could occur again as the pregnancy continued or during a vaginal delivery. The patient is aware that a hysterectomy may need to be performed if the placenta cannot be removed but will be avoided if at all possible. The patient also is known to have the baby in a double footling breech presentation and had gestational hypertension during this pregnancy. Labor was not allowed to occur in this patient. The patient is a 32 5/7 week gestation. FINDINGS: 1. Complete placenta previa 2. Viable male infant in double footling breech presentation. Weight 5 pounds ever. Apgar scores were 6 at one minute, 8 at five minutes, and 9 at ten minutes. The uterus did not have to be removed. There were normal-appearing tubes and ovaries. Of note: the pathologist reported on examination of the placenta that mild-to-moderate amnionitis was present in this mid third – trimester placenta. DESCRIPTION OF PROCEDURE: The patient was taken to the operating room, where a spinal anesthesia was found to be adequate. She was then prepped and draped in the normal, sterile fashion in the dorsal supine position with a leftward tilt. A Pfannenstiel skin incision was made with the scalpel and carried through to the underlying layer of the fascia. The fascia was incised in the midline, and the incision extended laterally with the use of Mayo scissors. The superior aspect of the fascial incision was then grasped with the Kocher clamps, and the underlying rectus muscles were dissected with the Mayo scissors. Attention was then turned to the inferior aspect of this incision, which in a similar fashion was grasped with the pickups and entered, and the underlying rectus muscles were dissected with the Mayo scissors. The rectus muscle was spread in the midline, and the peritoneum was entered bluntly. The peritoneum was extended superiorly and inferiorly, with good visualization of the bladder, using the Metzenbaum scissors. The bladder blade was placed and the vesico- uterine peritoneum was identified, tented up, and entered sharply with the Metzenbaum scissors. A bladder flap was then created digitally, and the bladder blade was replaced. The uterine incision was made about a centimeter and a half higher than usual due to the placenta previa, and the incision was widened with blunt force . At this time we were able to reach past the placenta previa and were able to grab both feet. At this point, the bag seemed to rupture . The infant was delivered in double footling breech with the typical breech maneuvers . The head delivered atraumatically . The nose and mouth were bulb suctioned . The cord was doubly clamped and cut. The infant was handed off to the waiting pediatrician . Cord gases and blood were obtained . The placenta was removed . The uterus was exteriorized and cleared of all clots and debris . The uterine incision was then repaired with a 0 Vicryl in a running , locked fashion, and a second layer of the same was used to ensure excellent hemostasis . The uterus was then replaced into the abdomen and the gutters were irrigated and cleared of all clots and debris. The peritoneum was repaired with a 2-0 Vicryl . The Vicryl was then used to reapproximate the rectus muscle in the midline . The fascia was repaired with a 0 Vicryl in a running fashion . The subcutaneous layer was then closed with plain 2-0 silk on a GI needle. The skin was closed with staples. The sponge, lap and needle counts were correct times two. The patient had been given a gram of Ancef at cord clamp. The patient was taken to the recovery room in stable condition Principal Dx: Secondary Dxs

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