Q Could you clarify the ICD-9 coding difference between secondary postpartum hemorrhage and third-stage postpartum hemorrhage?
A The third stage lasts until the entire placenta has been delivered. Therefore the diagnosis code for third-stage postpartum hemorrhage (666.0X) means that the baby was delivered, but that sometime before 24 hours elapsed, retained placenta caused bleeding. Secondary postpartum hemorrhage (666.2X) occurs more than 24 hours after delivery due to retained placenta.
Note that the code 666.1X, other immediate postpartum hemorrhage, is bleeding within the first 24 hours of delivery, but after delivery of the placenta.
Ms. Witt, former program manager in the Department of Coding and Nomenclature at the American College of Obstetricians and Gynecologists, is an independent coding and documentation consultant. Reimbursement Adviser reflects the most commonly accepted interpretations of CPT-4 and ICD-9-CM coding. When in doubt on a coding or billing matter, check with your individual payer.