Grávida admitida para substituição de duplo J calcificado

"Grávida de 26 semanas admitida para substituição de duplo J por calcificação do mesmo e litíase do ureter.

Não consigo encontrar o código de associação com a gravidez."


(Responde Fernando Lopes)

 
 
Trata-se de um episódio de complicação de cuidados (calcificação de cateter ureteral duplo J).
Se fosse uma admissão programada para substituição do cateter, na ausência de diagnóstico de complicação, seria um episódio de cuidados posteriores (aftercare).
De qualquer modo é uma grávida e não há indicação de que o médico tenha registado que a situação não afeta a gravidez, pelo que são aplicáveis as Guidelines:
 
Codes from chapter 15 and sequencing priority
Obstetric cases require codes from chapter 15, codes in the range O00-O9A, Pregnancy, Childbirth, and the Puerperium. Chapter 15 codes have sequencing priority over codes from other chapters. Additional codes from other chapters may be used in conjunction with chapter 15 codes to further specify conditions. Should the provider document that the pregnancy is incidental to the encounter, then code Z33.1, Pregnant state, incidental, should be used in place of any chapter 15 codes. It is the provider’s responsibility to state that the condition being treated is not affecting the pregnancy. (ICD-10-CM Official Guidelines for Coding and Reporting, FY 2019, Page 60 of 120)
 
Episodes when no delivery occurs
In episodes when no delivery occurs, the principal diagnosis should correspond to the principal complication of the pregnancy which necessitated the encounter. Should more than one complication exist, all of which are treated or monitored, any of the complications codes may be sequenced first. (ICD-10-CM Official Guidelines for Coding and Reporting, FY 2019, Page 62 of 120)
 
O diagnóstico principal deveria ser a gravidez complicada pela complicação do cateter duplo J, situação não contemplada na ICD-10-CM, pelo que resta a litíase renal a complicar a gravidez:
 
Pregnancy (single) (uterine) - see also Delivery and Puerperal
- complicated by (care of) (management affected by)
- - diseases of - see Pregnancy, complicated by, specified body system disease
- - - specified NEC O99.89
 
O99 Other maternal diseases classifiable elsewhere but complicating pregnancy, childbirth and the puerperium 
Includes: conditions which complicate the pregnant state, are aggravated by the pregnancy or are a main reason for obstetric care 
Use additional code to identify specific condition 
Excludes2: when the reason for maternal care is that the condition is known or suspected to have affected the fetus (O35-O36)
 
O99.8 Other specified diseases and conditions complicating pregnancy, childbirth and the puerperium
Conditions in D00-D48, H00-H95, M00-N99, and Q00-Q99
Use additional code to identify condition 
Excludes2: 
genitourinary infections in pregnancy (O23.-)
infection of genitourinary tract following delivery (O86.1-O86.3)
malignant neoplasm complicating pregnancy, childbirth and the puerperium (O9A.1-)
maternal care for known or suspected abnormality of maternal pelvic organs (O34.-)
postpartum acute kidney failure (O90.4)
traumatic injuries in pregnancy (O9A.2-)
 
O99.89 Other specified diseases and conditions complicating pregnancy, childbirth and the puerperium
 
Teremos então:
 
O99.89     Other specified diseases and conditions complicating pregnancy, childbirth and the puerperium
N20.1       Calculus of ureter
T83.192A Other mechanical complication of indwelling ureteral stent, initial encounter
Z3A.26     26 weeks gestation of pregnancy
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