AHA Coding Clinic® for ICD-9 - 2011 Issue 2; Ask the Editor

Imperforate Anus with Perineal Fistula

A term newborn was transferred to our hospital and underwent Pena anorectoplasty for imperforate anus with perineal fistula. In ICD-9-CM the index leads to codes 751.2, Atresia and stenosis of large intestine, rectum, and anal canal, for imperforate anus, and 599.1, Urethral fistula, for perineal fistula. In this case, code 599.1 seems incorrect because the perineal fistula is a component of the imperforate anus (anorectal defect). The guidelines state that manifestations that are an inherent component of the anomaly should not be coded separately. However, the guidelines also state that if the index does not provide a specific code for a perinatal condition, code 779.89 is assigned. Is it appropriate to report 751.2 and 599.1 along with 779.89 to describe this condition? ...

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