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Scenario Week of November 29, 2012:
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Assign the appropriate ICD-9-CM and ICD-10-CM/PCS diagnosis and procedure codes.

CHIEF COMPLAINT: Pregnant patient with fever, nausea and vomiting

SCENARIO: A 27-year-old G1P1A0 patient at 29 weeks gestation presents in moderate distress with high fever and flu-like gastrointestinal illness. Course of pregnancy is otherwise uneventful, without prior complications. Symptoms suspicious for gastrointestinal viral illness or possible food poisoning.

CLINICAL COURSE: The patient was admitted and placed on IV hydration. Preliminary blood culture results were positive for gram-positive bacteremia. The final blood culture was positive for Listeria monocytogenes. Organism attributed to known contaminated unpasteurized cheese product consumed by patient 3 weeks prior per CDC cluster. Fetal monitoring was negative for signs of distress. Amniocentesis was performed with negative findings. The patient’s penicillin allergy necessitated initiation of alternate therapy with Trimethoprim Sulfamethoxazole; 300 mg of TMP-SMX every 6 hours for 4 weeks. The patient was discharged in improved condition, with resolution of fever and gastrointestinal symptoms. She will follow up with her obstetrician to monitor her course of therapy and continue surveillance of fetus.

PROCEDURE: The patient was positioned and abdomen prepped for procedure. Under ultrasound guidance, an amniocentesis needle was inserted through the abdominal wall into the interior of the pregnant uterus and directly into the amniotic sac. Approximately 25 cc amniotic fluid was withdrawn for analysis.

DIAGNOSIS: Listeria monocytogenes septicemia with food poisoning in 29 week pregnancy.

Code This! Assign the correct ICD-9-CM and ICD-10-CM/PCS diagnosis and procedure codes.

ICD-9-CM Diagnosis Codes
647.83 Infectious and parasitic conditions complicating pregnancy; other specified infectious and parasitic diseases, antepartum condition or complication
027.0 Listeriosis
005.89 Other bacterial food poisoning
V14.0 Personal history of allergy to medicinal agents; penicillin

ICD-9-CM Procedure Code
75.1 Amniocentesis

ICD-9-CM Rationale
Assign code 647.83 as the principal diagnosis. Official coding guideline I.C.11.a designates sequencing priority of obstetric codes over codes from other chapters. Instructional notes at category 647 prompt reporting of additional codes to further specify the nature of the infection. Code 027.0 reports the specific organism and includes septicemia due to Listeriosis. Instruction at code 027.0 prompts reporting additional codes to identify the manifestation. Assign code 005.89 to provide additional information regarding the gastrointestinal manifestation of illness and route infection as food contamination.

ICD-10-CM Diagnosis Codes
O98.813 Other maternal infectious and parasitic diseases complicating pregnancy, third trimester
A32.7 Listerial sepsis
Z88.0 Allergy status to penicillin
Z3A.29 29 weeks gestation of pregnancy

ICD-10-PCS Procedure Code
10903ZU Drainage of amniotic fluid, diagnostic from products of conception, percutaneous approach

Similar to ICD-9-CM, official ICD-10-CM coding guideline I.C.15.a.1 designates sequencing priority of obstetric codes over codes from other chapters. ICD-10-CM provides combination codes which include the organism and manifestation of illness. Use additional codes with category O98 to identify the infectious agent. Category A32 includes listerial foodborne infection. Assign code A32.7 Listerial sepsis. Category A05 lists Listeriosis infection as an Excludes 1 condition, precluding assignment of code A05.8. Index amniocentesis as a root operation (9) Drainage procedure. The obstetrics section in ICD-10-PCS includes procedures performed on the products of conception (POC) only, which refers to all physical components of a pregnancy, including the fetus, amnion, umbilical cord and placenta. Seventh character U reports drainage of amniotic fluid (specific POC) for diagnostic purposes.

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