Understanding Delivery Complicated by Cord Avulsion (Umbilical Cord Avulsion, Cord Evulsion): This resource provides essential information for healthcare professionals on diagnosing and documenting ICD-10 code O69.4 for cord avulsion during delivery. Learn about clinical documentation requirements, medical coding best practices, and potential complications associated with umbilical cord avulsion to ensure accurate and complete medical records.
Also known as
Other complications of the cord
This code specifies other umbilical cord complications, including avulsion.
Delivery with laceration
While not specific to cord avulsion, it covers perineal lacerations that may occur concurrently.
Complications of labor and delivery
This broader category encompasses various delivery complications, including those related to the cord.
Follow this step-by-step guide to choose the correct ICD-10 code.
Was the cord avulsion during delivery?
Yes
Was the baby delivered?
No
Do not code cord avulsion. Code the underlying condition causing the cord problem if applicable.
When to use each related code
| Description |
|---|
| Umbilical cord tears away from the placenta. |
| Short umbilical cord restricts fetal movement. |
| Cord wraps around fetal neck, compromising blood flow. |
Coding requires specifying the umbilical cord site of avulsion (fetal or placental) for accurate reporting and reimbursement.
Insufficient documentation of associated conditions like fetal distress or birth trauma can lead to undercoding and lost revenue.
Unclear documentation of the causal relationship between cord avulsion and other complications may impact coding accuracy and clinical validation.
Q: What are the immediate management steps for umbilical cord avulsion during delivery?
A: Umbilical cord avulsion, a rare but serious obstetric emergency, requires prompt and decisive action. Immediately upon diagnosis, which often presents with sudden fetal bradycardia and profuse vaginal bleeding, the priority is to expedite delivery while ensuring fetal oxygenation. This may involve assisted vaginal delivery with forceps or vacuum if the presenting part is low, or emergency cesarean section if not. Simultaneously, initiate aggressive resuscitation of the neonate, including immediate cord clamping to prevent further blood loss, and provide adequate ventilation and circulatory support. Explore how implementing a standardized emergency protocol can improve team response and potentially mitigate adverse neonatal outcomes in cases of cord evulsion. Consider implementing fetal monitoring throughout labor, particularly in cases with risk factors such as velamentous cord insertion or vasa previa, to allow for early detection of potential complications.
Q: How can I differentiate between umbilical cord rupture and cord avulsion during delivery, and what are the distinct implications for management?
A: While both umbilical cord rupture and cord avulsion are associated with fetal distress and hemorrhage, they differ significantly in their pathophysiology and management implications. Cord rupture involves a tear or break in the umbilical cord itself, often associated with traumatic delivery maneuvers or a short cord. Cord avulsion, on the other hand, represents a complete separation of the umbilical cord from the placental insertion site, commonly seen in velamentous cord insertion or vasa previa. Differentiating between these two conditions is crucial. Cord rupture can often be managed expectantly with close monitoring if the bleeding is controlled and the fetus is stable. However, cord avulsion necessitates immediate delivery and aggressive neonatal resuscitation. Learn more about the specific risk factors associated with each condition and consider implementing prenatal ultrasound screening protocols for early detection of velamentous cord insertion or vasa previa to optimize perinatal outcomes.
Patient presented with umbilical cord avulsion, diagnosed during labor and delivery. Fetal monitoring demonstrated signs of fetal distress prior to delivery, including variable decelerations and bradycardia. Upon delivery, the umbilical cord was noted to be completely separated from the placental insertion site. Examination of the neonate revealed signs of hypoxic ischemic encephalopathy (HIE). Resuscitation efforts were initiated immediately following delivery, including positive pressure ventilation and umbilical venous catheterization. Apgar scores were low at 1 and 5 minutes. Differential diagnosis considered placental abruption, vasa previa, and umbilical cord prolapse, however, clinical findings were consistent with cord avulsion. This obstetric emergency resulted in significant neonatal morbidity. Maternal history includes (insert relevant history, such as gestational age, parity, prior pregnancies, complications of pregnancy, etc.). Treatment plan includes ongoing neonatal intensive care, monitoring for complications of HIE, and supportive care. ICD-10 code O69.4 for delivery complicated by cord avulsion is documented. Potential long-term sequelae of cord avulsion and HIE were discussed with the patient and family.