ICD How would you code Rh negative and ABS negative.

[Sara Gomez]

Please help to code for a pregnant pt, provider stated Rh negative, s/p rhogam with DX 656.10
There no documentation to support there are complications. Thank you in advance for any direction.

 

[Carolyn Heath]

This is what I was told when I took my PMCC class: If there is no documentation to support any complications, ask the physician to clarify any complications so that you can code correctly.

 

[Alicia Scott]

I am looking Sara for a code to cover Rh- and have not found it yet. This is ignorance on my part. I will find something for you though. It is necessary to document that the patient is Rh- as this can affect the baby's health. The mother is usually fine. Now they don't have as many complications because of the shot Rh immunoglobin, that can be given and better testing. One shot is given prior to deliver and I think one afterwards. If I remember correctly it is only done once in a life time so future Rh+ babies are not affected.

You see your blood type is not just a letter but - or + and that is called the Rh factor. This doesn't cause any trouble unless the Mother is - and the baby is +. Then you have a situation where there are two different blood types so to speak. Now, if there is blood transfer then the baby's body will go into rejection mode. With the Rh immunoglobin, which I think we called the Rh factor shot back when I did clinical work, that protects the baby. I believe it adds a protein layer in the Mother's blood system. It is very detailed and I can't remember all of it. (This would make a great webinar slide though).

Sara I think is looking for a Dx code that will show the Mother's Rh factor -. If anyone else finds it before I do jump right in.
Oh, Carolyn I think maybe the no mention of complication is meaning that nothing has happened, YET. The potential is there.

 

[Alicia Scott]

Found so more info here: http://www.healthline.com/health-blogs/fruit-womb/rh-isoimmunization
When a person is found to be isoimmunized to Rh (or any other blood group system), the amount of antibody present, or degree of isoimmunization, is usually expressed as an antibody ‘titer.’ A titer is determined by how many times the blood can be diluted and still have the antibody detectable. In this context, the lower the number, the fewer antibodies are present. At the risk of oversimplification, in the case of Rh-isoimmunization, antibody titers less than 16 (or sometimes described as 1 to 16) are rarely associated with severe fetal complications during pregnancy; and, the higher the titer, the greater the likelihood of fetal complications. Baby’s are also at increased risk if the maternal antibody titer rises during the pregnancy or if the mother has previously had a severely affected baby. Usually, if a woman is found (or known) to be Rh-sensitized, she can expect to have monthly antibody titers performed during the course of her pregnancy. If maternal titers are low, and remain low, the baby may be Rh-negative, or may simply be at very low risk and no significant interventions may be required during the pregnancy. If the titers are rising, the baby is more likely to be Rh-positive and, therefore, ‘at risk’ and the pregnancy may require more intensive surveillance, including noninvasive or invasive assessment of the fetal status during the pregnancy.

 

[Alicia Scott]

V28.5 - Antenatal; screening for isoimmunization

V07.2 - Prophylactic immunotherapy

3290F - Patient is D (Rh) negative and unsensitized (Pre-Cr)

If there is no complication the patient is considered unsensitized. That is because her body is not doing anything to react to the baby being a positive when the mother is a negative.

Hope this helps.

 

[Carolyn Heath]

Thanks, Alicia, for clearing that up. Where do you look for it in the document? What key words are you looking for?

 

[Alicia Scott]

I would find it in the HPI. You are going to see lab work as well. Rh factor is how I have always seen it written or have heard it referred to as that.

 

[Carolyn Heath]

Thank you, Alicia!