New subgaleal hemorrhage code.(Research Implications)

Beginning in October, physicians who deliver a baby that sustains a subgaleal hemorrhage should begin using a new diagnosis code for the injury.

The new code, 767.11, will be used instead of 767.1 and was developed to separate subgaleal hemorrhage from other birth injuries, said Dr. Victor Vines of Medical City Hospital in Dallas.

"This particular injury has been erroneously reported for decades because we've never had an ability to code it accurately," he said. "It's been lumped into a category of injuries that are really benign and nonsignificant to fetal outcome."

In addition to subgaleal hemorrhage, code 767.1 was used to indicate diagnoses of caput succedaneum, cephalhematoma, and chignon, a situation that made it difficult to track the incidence and causes of subgaleal hemorrhage.

"Because [subgaleal hemorrhage] is such a big injury and has severe implications for the baby--and therefore legal implications for the doctor and the hospital--if we try to do procedures to decrease its incidence and don't have way of tracking whether there's any benefit to the things we're doing, then we're shooting in the dark," he said.

Interest in subgaleal hemorrhage intensified in 1998, when the Food and Drug Administration issued a public health advisory about complications with vacuum-assisted deliveries. "Over the past 4 years, FDA has received reports of 12 deaths and nine serious injuries among newborns on whom vacuum-assisted delivery devices were used," the advisory said. "[Although I the total number of serious complications reported to FDA from vacuum-assisted delivery devices remains small in relation to the total number of births per year in which these devices are used ... we are concerned that at least some of these complications might be avoidable."

That year, Dr. Vines was section chief at his hospital when a subgaleal hemorrhage occurred during a delivery. "l started paying attention to those injuries," he said. In addition, the Hospital Corporation of America, which owned Dr. Vines' hospital, started a Perinatal Risk Management Initiative to develop ways to prevent maternal and fetal injuries, including injuries related to forceps and vacuum deliveries.