Although the US is still waiting on legislative or regulatory action establishing an ICDCM implemention date, HIM professionals should start familiarizing themselves with the classification system to prepare for its future use. ICDCM includes the level of detail needed for morbidity classification and diagnostic specificity. It also provides code titles and language that complement accepted clinical practice. ICDCM codes have the potential to reveal more about quality of care, so that data can be used in a more meaningful way to better understand complications, better design clinically robust algorithms, and better track the outcomes of care. ICDCM incorporates greater specificity and clinical detail to provide information for clinical decision making and outcomes research. ICDCM codes may consist of up to seven digits, with the seventh digit extensions representing visit encounter or sequelae for injuries and external causes.
Coding guidelines are also in the index. The two parts of the ICDCM index are the index to diseases and injury and index to external causes of injury. The table of drugs and chemicals and the neoplasm table are housed in the index to diseases and injury. The table above provides a comparison of the two classification systems.
The difference in code structure is shown in the figure above. ICDCM has numerous new features allowing for a greater level of specificity and clinical detail. These include:. ICDCM also includes added standard definitions for two types of excludes notes. Excludes1 indicates not coded here. The code being excluded is never used with the code.
The two conditions cannot occur together. Excludes2 indicates not included here. The excluded condition is not part of the condition represented by the code. It is acceptable to use both codes together if the patient has both conditions. For example, J An additional feature is the expansion of codes for certain conditions.
Two examples are diabetes mellitus and postoperative complication codes. Three-dimensional ultrasound appears to have been useful in research on fetal embryology. However, there is no evidence that the results of 3D ultrasound alters clinical management over standard 2D ultrasound such that clinical outcomes are improved.
Whether 3D ultrasound will provide unique, clinically relevant information remains to be seen. Despite these technical advantages, proof of a clinical advantage of 3-dimensional ultrasonography in prenatal diagnosis in general is still lacking. Potential areas of promise include fetal facial anomalies, neural tube defects, and skeletal malformations where 3-dimensional ultrasonography may be helpful in diagnosis as an adjunct to, but not a replacement for, 2-dimensional ultrasonography.
Until clinical evidence shows a clear advantage to conventional 2-dimensional ultrasonography, 3-dimensional ultrasonography is not considered a required modality at this time. Their use in fetal medicine varies with the nature of the tissue to be imaged and the challenges each organ system presents, versus the advantages of each ultrasound application. Fetal applications include all types of anatomical assessment, morphometry and volumetry, as well as functional assessment.
They had successful fetal nasal bone measurement by 2D US by 4 operators. Three-dimensional volumes were recorded in the mid-sagittal plane of fetal profile by the 5th operator and examined using multi-planar techniques. In the subsequent 3D examination, the nasal bone length could be examined in 94 cases The mean difference between the 2D and 3D measurements was 0.
Limits of agreement were The authors concluded that there was significant inter-method difference between the results obtained by 2D and 3D, as well as substantial inter-observer variation in 3D measurement of fetal nasal bone length in the 1st trimester.
They stated that independent 3D measurement of nasal bone offers no additional advantages over 2D US.
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Kurjak and colleagues stated that an evolving challenge for obstetricians is to better define normal and abnormal fetal neurological function in utero in order to better predict ante-natally which fetuses are at risk for adverse neurological outcome.
In a multi-center study, these investigators examined the use of 4D US in the assessment of fetal neurobehavior in high-risk pregnancies. It was revealed that fetuses were neurologically normal, 7 abnormal and 25 borderline.
Out of 7 abnormal fetuses ATNAT was borderline in 5 and abnormal in 2, whereas GM assessment was abnormal in 5 and definitely abnormal in 2.
Dating is icd 10 Chin June 04, Aapc for gynecolog y and icd is currently in may be used to indicate a billable/specific icdcm code or large for claims? 88 encounter for the american icdcm n An ultrasound was published under the /19 edition of may by the latest motorbike reviews and related health problems icd coding system. Injection, levetiracetam, 10 mg: ICD codes covered (for detailed fetal ultrasounds) if selection criteria are met: A Zika virus disease: A Other specified mosquito-borne viral fevers: B - B Rubella [German measles] B - B Malaria: B Parvovirus as the cause of diseases classified elsewhere: E Mar 04, There is not ICD9 code for "dating the pregnancy" but your options will include V (done to look for malformations, but routinely) or V (done to do an anatomic survey which would be required to date the pregnancy) or V or V (when done on all patients just because they are pregnant).
In summary, out of 32 borderline and abnormal fetuses, ATNAT was normal in 7, borderline in 22 and abnormal in 3; GM assessment was normal optimal in 4, normal suboptimal in 20, abnormal in 6 and definitely abnormal in 2. The authors concluded that 4D US requires further studies before being recommended for wider clinical practice. The parents and families could readily understand the fetal conditions and undergo counseling; they then choose the option of termination of pregnancy.
In a pilot study, Antsaklis et al evaluated the use of 3D ultrasonography as an alternative for examining fetal anatomy and nuchal translucency NT in the first trimester of pregnancy.
A total of low-risk pregnant women undergoing 1st trimester ultrasound scan for fetal anomalies were included in this study. The NT and fetal anatomy were evaluated by 3D ultrasonography after the standard 2D examination.
The gold standard in this study was the 2D ultrasonography. In some of the evaluated parameters, the 3D method approaches the conventional 2D results. These parameters are the crown-rump length CRLthe skull-brain anatomy Some of the anatomic parameters under evaluation revealed a statistically significant difference in favor of the 2D examination.
During the 3D examination the nasal bone was identified in The authors concluded that the 3D ultrasound is insufficient for the detailed fetal anatomy examination during the 1st trimester of pregnancy.
An UpToDate review on "Idiopathic pulmonary hemosiderosis" Milman, does not mention the use of detailed ultrasound fetal anatomic examination. According to the Product Insert of Keppra Pregnancy Category Cthere are no adequate and well-controlled studies in pregnant women. In animal studies, levetiracetam produced evidence of developmental toxicity, including teratogenic effects, at doses similar to or greater than human therapeutic doses.
Keppra should be used during pregnancy only if the potential benefit justifies the potential risk to the fetus.
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As with other anti-epileptic drugs, physiological changes during pregnancy may affect levetiracetam concentration. There have been reports of decreased levetiracetam concentration during pregnancy.
Discontinuation of anti-epileptic treatments may result in disease worsening, which can be harmful to the mother and the fetus. In a Cochrane review, Grivell et al noted that policies and protocols for fetal surveillance in the pregnancy where impaired fetal growth is suspected vary widely, with numerous combinations of different surveillance methods.
These researchers evaluated the effects of ante-natal fetal surveillance regimens on important peri-natal and maternal outcomes. Randomized and quasi-randomized trials comparing the effects of described ante-natal fetal surveillance regimens were selected for analysis.
Review authors independently assessed trial eligibility and quality and extracted data. They included 1 trial of women and their babies. This trial was a pilot study recruiting alongside another study, therefore, a separate sample size was not calculated. The trial compared a twice-weekly surveillance regimen biophysical profile, non-stress tests, umbilical artery and middle cerebral artery Doppler and uterine artery Doppler with the same regimen applied fortnightly both groups had growth assessed fortnightly.
There were insufficient data to assess this review's primary infant outcome of composite peri-natal mortality and serious morbidity although there were no peri-natal deaths and no difference was seen in the primary maternal outcome of emergency caesarean section for fetal distress risk ratio RR 0. In keeping with the more frequent monitoring, mean gestational age at birth was 4 days less for the twice-weekly surveillance group compared with the fortnightly surveillance group mean difference MD The authors concluded that there is limited evidence from randomized controlled trials to inform best practice for fetal surveillance regimens when caring for women with pregnancies affected by impaired fetal growth.
They stated that more studies are needed to evaluate the effects of currently used fetal surveillance regimens in impaired fetal growth. A choroid plexus cyst is a small fluid-filled structure within the choroid of the lateral ventricles of the fetal brain.
According to the Society for Maternal-Fetal Medicine SMFM,when a choroid plexus cyst is identified, the presence of structural malformations and other sonographic markers of aneuploidy should be assessed with a detailed fetal anatomic survey performed by an experienced provider.
If no other sonographic abnormalities are present, the choroid plexus cyst is considered isolated. Gindes et al evaluated the ability of 3D ultrasound for demonstrating the palate of fetuses at high-risk for cleft palate.
A detailed assessment of palate was made using both 2D and 3D ultrasounds on the axial plane. Antenatal diagnoses were compared with post-natal findings. Cleft palate was suspected in 13 Sensitivity, specificity, positive-predictive value, and negative-predictive value of detection of palatal clefts were Kanenishi et al evaluated the frequency of fetal facial expressions at 25 to 27 weeks of gestation using 4D ultrasound. A total of 24 normal fetuses were examined using 4D ultrasound. The face of each fetus was recorded continuously for 15 mins.
The frequencies of tongue expulsion, yawning, sucking, mouthing, blinking, scowling, and smiling were assessed and compared with those observed at 28 to 34 weeks of gestation in a previous study. The authors concluded that the results indicated that facial expressions can be used as an indicator of normal fetal neurologic development from the 2nd to the 3rd trimester. They stated that 4D ultrasound may be a valuable tool for assessing fetal neurobehavioral development during gestation.
These preliminary findings need to be validated by well-designed studies. Votino et al evaluated prospectively the use of 4D spatio-temporal image correlation STIC in the evaluation of the fetal heart at 11 to 14 weeks' gestation. The study involved off-line analysis of 4D-STIC volumes of the fetal heart acquired at 11 to 14 weeks' gestation in a population at high-risk for congenital heart disease CHD.
Regression analysis was used to investigate the effect of gestational age, maternal body mass index, quality of the 4D-STIC volume, use of a trans-vaginal versus trans-abdominal probe and use of color Doppler ultrasonography on the ability to visualize separately different heart structures. A total of fetuses with a total of STIC volumes were included in this study. Regression analysis showed that the ability to visualize different heart structures was correlated with the quality of the acquired 4D-STIC volumes.
Independently, the use of a trans-vaginal approach improved visualization of the 4-chamber view, and the use of Doppler improved visualization of the outflow tracts, aortic arch and inter-ventricular septum. Follow-up was available in of the fetuses, of which 27 had a confirmed CHD.
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Early fetal echocardiography using 2D ultrasound was possible in all fetuses, and accuracy in diagnosing CHD was The authors concluded that in fetuses at 11 to 14 weeks' gestation, the heart can be evaluated offline using 4D-STIC in a large number of cases, and this evaluation is more successful the higher the quality of the acquired volume. Moreover, they stated that 2D ultrasound remains superior to 4D-STIC at 11 to 14 weeks, unless volumes of good to high quality can be obtained.
Ahmed stated that CHD is the commonest congenital anomaly. It is much more common than chromosomal malformations and spinal defects.
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Its' estimated incidence is about 4 to 13 per 1, live births. Congenital heart disease is a significant cause of fetal mortality and morbidity. Antenatal diagnosis of CHD is extremely difficult and requires extensive training and expertise. Spatio-temporal image correlation is an automated device incorporated into the ultrasound probe and has the capacity to perform slow sweep to acquire a single 3D volume. This acquired volume is composed of a great number of 2D frames.
This volume can be analyzed and re-analyzed as required to demonstrate all the required cardiac views. It also provides the examiner with the ability to review all images in a looped cine sequence. The author concluded that this technology has the ability to improve the ability to examine the fetal heart in the acquired volume and decrease examination time; it is a promising tool for the future.
Tonni et al described the application of a novel 3D ultrasound reconstructing technique OMNIVIEW that may facilitate the evaluation of cerebral midline structures at the 2nd trimester anatomy scan. Fetal cerebral midline structures from consecutive normal low-risk pregnant women were studied prospectively by 2D and 3D ultrasound between 19 to 23 weeks of gestation. In addition, 5 confirmed pathologic cases were evaluated and the abnormal features using this technique were described in this clinical series.
Off-line volume data sets displaying the corpus callosum and the cerebellar vermis anatomy were accurately reconstructed in For pathological cases, an agreement rate of 0.
The authors concluded that this study demonstrated the feasibility of including 3D ultrasound as an adjunct technique for the evaluation of cerebral midline structures in the 2nd trimester fetus.
Moreover, they stated that future prospective studies are needed to evaluate if the application of this novel 3D reconstructing technique as a step forward following 2D second trimester screening scan will improve the prenatal detection of cerebral midline anomalies in the low-risk pregnant population. Sharp et al noted that fetal assessment following PPROM may result in earlier delivery due to earlier detection of fetal compromise.
However, early delivery may not always be in the fetal or maternal interest, and the effectiveness of different fetal assessment methods in improving neonatal and maternal outcomes is uncertain. In a Cochrane review, these researchers examined the effectiveness of fetal assessment methods for improving neonatal and maternal outcomes in PPROM. Examples of fetal assessment methods that would be eligible for inclusion in this review include fetal cardiotocography, fetal movement counting and Doppler ultrasound.
Randomized controlled trials RCTs comparing any fetal assessment methods, or comparing one fetal assessment method to no assessment were selected for analysis.
10/ Transition to ICD Frequently Asked Questions Page 2 of 9 Independence Blue Cross offers products through its subsidiaries Independence Hospital Indemnity Plan, Keystone Health Plan East and QCC Insurance Company, and with Highmark Blue Shield - independent licensees of the Blue Cross and Blue Shield Association. File Size: 1MB. Oct 01, ICDCM Diagnosis Code Z Encounter for antenatal screening for uncertain dates. - New Code Billable/Specific Code Maternity Dx ( years) POA Exempt. Z is a billable/specific ICDCM code that can be used to indicate a diagnosis for reimbursement purposes. The edition of ICDCM Z became. Oct 01, OX0 is a billable/specific ICDCM code that can be used to indicate a diagnosis for reimbursement purposes. The edition of ICDCM OX0 became effective on October 1, This is the American ICDCM version of OX0 - other international versions of ICD OX0 may differ. OX0 is applicable to maternity.
Two review authors independently assessed trials for inclusion into the review. The same 2 review authors independently assessed trial quality and independently extracted data. Data were checked for accuracy. These researchers included 3 studies involving women data reported for with PPROM at up to 34 weeks' gestation. All 3 studies were conducted in the United States. Each study investigated different methods of fetal assessment. These investigators were unable to perform a meta-analysis, but were able to report data from individual studies.
There was no convincing evidence of increased risk of neonatal death in the group receiving endovaginal ultrasound scans compared with the group receiving no assessment risk ratio RR 7.
For both these interventions, these researchers inferred that there were no fetal deaths in the intervention or control groups. The study comparing daily non-stress testing with daily modified biophysical profiling did not report fetal or neonatal death.
Primary outcomes of maternal death and serious maternal morbidity were not reported in any study. Overall, there were few statistically significant differences in outcomes between the comparisons.
The overall quality of evidence was poor, because participant blinding was not possible for any study. The authors concluded that there is insufficient evidence on the benefits and harms of fetal assessment methods for improving neonatal and maternal outcomes in women with PPROM to draw firm conclusions.
The overall quality of evidence that does exist is poor. They stated that further high-quality RCTs are needed to guide clinical practice. In a Cochrane review, Alfirevic et al examined the effects on obstetric practice and pregnancy outcome of routine fetal and umbilical Doppler ultrasound in unselected and low-risk pregnancies.
These investigators searched the Cochrane Pregnancy and Childbirth Group Trials Register February 28, and reference lists of retrieved studies. Randomized and quasi-randomized controlled trials of Doppler ultrasound for the investigation of umbilical and fetal vessels waveforms in unselected pregnancies compared with no Doppler ultrasound were selected for analysis. Studies where uterine vessels have been assessed together with fetal and umbilical vessels have been included.
Two review authors independently assessed the studies for inclusion, assessed risk of bias and carried out data extraction. In addition to standard meta-analysis, the 2 primary outcomes and 5 of the secondary outcomes were assessed using GRADE software and methodology. These researchers included 5 trials that recruited 14, women, with data analyzed for 14, women. All trials had adequate allocation concealment, but none had adequate blinding of participants, staff or outcome assessors.
Overall and apart from lack of blinding, the risk of bias for the included trials was considered to be low. Overall, routine fetal and umbilical Doppler ultrasound examination in low-risk or unselected populations did not result in increased antenatal, obstetric and neonatal interventions.
There were no group differences noted for the review's primary outcomes of perinatal death and neonatal morbidity. Results for perinatal death were as follows: average RR 0. Only 1 included trial assessed serious neonatal morbidity and found no evidence of group differences RR 0. For the comparison of a single Doppler assessment versus no Doppler, evidence for group differences in perinatal death was detected RR 0.
However, these results are based on a single trial, and these researchers would recommend caution when interpreting this finding. There was no evidence of group differences for the outcomes of caesarean section, neonatal intensive care admissions or preterm birth of less than 37 weeks. Evidence for admission to neonatal intensive care unit was assessed as of moderate quality, and evidence for the outcomes of caesarean section and preterm birth of less than 37 weeks was graded as of high quality.
There was no available evidence to assess the effect on substantive long-term outcomes such as childhood neurodevelopment and no data to assess maternal outcomes, particularly maternal satisfaction. The authors concluded that existing evidence does not provide conclusive evidence that the use of routine umbilical artery Doppler ultrasound, or combination of umbilical and uterine artery Doppler ultrasound in low-risk or unselected populations benefits either mother or baby.
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