Title

Basic ICD-10-CM/PCS Coding2013 EditionChapter 18: Pregnancy, Childbirth, and the Puerperium (O00O9A) 2013 2013Learning ObjectivesReview the chapters learning objectives and key termsConcepts in this chapter may require extra study time and coding of conditions related to pregnancy may be more difficult than other chapters of ICD-10-CM/PCSCoding of obstetrical conditions requires special attention to definitions and detailsAt the conclusion of this chapter, what must you know about pregnancy, childbirth and the puerperium to code these conditions and the related therapeutic procedures?

2013 2013This is one of the challenge chapters. Look at the number of guidelines!2Chapter 15 of ICD-10-CM, Pregnancy, Childbirth and the Puerperium (O00O9A)

First character of code is letter O, not zeroThese codes used on mothers record, not infants record 2013 2013Two important points3Chapter 15 of ICD-10-CM, Pregnancy, Childbirth and the Puerperium (O00O9A)

The blocks of codes in Chapter 15 areO00O08 Pregnancy with abortive outcomeO09 Supervision of high risk pregnancyO10O16 Edema, proteinuria and hypertensive disorders in pregnancy, childbirth and puerperiumO20O29 Other maternal disorders predominantly related to pregnancyO30O48 Maternal care related to the fetus and amniotic cavity and possible delivery problems 2013 2013Chapter 15 of ICD-10-CM, Pregnancy, Childbirth and the Puerperium (O00O9A)

The blocks of codes in Chapter 15 areO60O77 Complications of labor and deliveryO80, O82 Encounter for deliveryO85O92 Complications predominantly related to the puerperiumO94O9A Other obstetric conditions, not elsewhere classified 2013 2013Chapter 15 of ICD-10-CM, Pregnancy, Childbirth and the Puerperium (O00O9A)

ICD-10-CM codes identifies the trimester in which the condition occurred at the 5th and 6th character level 2013 2013Not for ALL codes, just some6Chapter 15 of ICD-10-CM, Pregnancy, Childbirth and the Puerperium (O00O9A)

Codes for elective (legal or therapeutic) abortion has been moved to code Z33.2, Encounter for elective termination of pregnancy, in Chapter 21 of ICD-10-CM.Index entry isEncounter (for), termination of pregnancy, elective 2013 2013In ICD-9-CM this code was in the OB chapter7Chapter 15 of ICD-10-CM, Pregnancy, Childbirth and the Puerperium (O00O9A)

Codes for spontaneous abortions, complications following (induced) termination of pregnancy, failed attempted termination of pregnancy and other conditions describing pregnancy with abortive outcome are included in the block of codes O00O08 2013 2013Chapter 15 of ICD-10-CM, Pregnancy, Childbirth and the Puerperium (O00O9A)

ICD-10-CM requires the use of a seventh character extension to identify the fetus to which certain complication codes apply, including a seventh character for unspecified when the fetus affected cannot be identifiedExample:0 not applicable or unspecified1 fetus 12fetus 23fetus 34 fetus 45fetus 59other fetus

2013 2013Again only some codes, and not many. Use 0 for ANY single gestation or when unspecified9Coding Instructional Notes for ICD-10-CM Chapter 15

Notes appear in the chapter to direct the coderPostpartum period begins immediately after delivery and continues for six weeks following deliveryA postpartum complication is any complication occurring within the six-week period 2013 2013Coding Instructional Notes for ICD-10-CM Chapter 15

Trimesters are counted from the first day of the last menstrual period and defined as1st trimester: less than 14 weeks 0 days2nd trimester: 14 weeks 0 days to less than 28 weeks 0 days3rd trimester: 28 weeks 0 days until delivery 2013 2013For when applicable. If provider gives the # of weeks, permissible to translate this into trimester. Cannot do this based on the Last Menstrual Period (LMP)11Coding Instructional Notes for ICD-10-CM Chapter 15

Another note appears at the start of Chapter 15 that instructs the coder to use an additional code from category Z3A, Weeks of gestation, to identify the specific week of pregnancy 2013 2013Handy that the last 2 characters = the number of weeks12Coding Guidelines for ICD-10-CM Chapter 15

NCHS has published chapter-specific guidelines for ICD-10-CM General rules for obstetric casesSelection of OB principal or first-listed diagnosisPre-existing conditions versus conditions due to the pregnancyPre-existing hypertension in pregnancyFetal conditions affecting the management of the mother

2013 2013Here come the guidelines!13Coding Guidelines for ICD-10-CM Chapter 15

NCHS has published chapter-specific guidelines for ICD-10-CM (continued)HIV infection in pregnancy, childbirth and the puerperiumDiabetes mellitus in pregnancyLong term use of insulinGestational (pregnancy induced) diabetesSepsis and septic shock complicating abortion, pregnancy, childbirth and the puerperium

2013 2013Coding Guidelines for ICD-10-CM Chapter 15

NCHS has published chapter-specific guidelines for ICD-10-CM (continued)Puerperal sepsisAlcohol and tobacco use during pregnancy, childbirth and the puerperiumPoisoning, toxic effects, adverse effects and underdosing in a pregnant patientNormal delivery, Code O80

2013 2013Coding Guidelines for ICD-10-CM Chapter 15

NCHS has published chapter-specific guidelines for ICD-10-CM (continued)The peripartum and postpartum periodsSequelae of complication of pregnancy, childbirth and the puerperiumAbortionsAbuse in a pregnant patient

2013 2013Coding Conditions for ICD-10-CM Chapter 15

Codes begin with the letter O, not zero (0)Codes include both letters and numbersO00Letter O, digit zero, digit zeroChapter 15 codes are used only on maternal records and never on newborn infant recordsThese are conditions related to or aggravated by the pregnancy, childbirth, or by the puerperium or maternal causes or obstetric causes 2013 2013Coding Conditions for ICD-10-CM Chapter 15

The majority of codes have a final character indicating the trimester of pregnancy.The time frames for the trimesters are:First Trimester: less than 14 weeks, 0 daysSecond Trimester: 14 weeks, 0 days to less than 28 weeks, 0 daysThird Trimester: 28 weeks, 0 days until delivery

2013 2013Coding Conditions for ICD-10-CM Chapter 15

Assignment of final character for trimester is based on the trimester for the current admission or encounterWhenever delivery occurs during the current admission and there is an in childbirth option for the obstetric complication being coded, the in childbirth code should be assigned

2013 2013Coding Conditions for ICD-10-CM Chapter 15

Pregnancy-Related Codes in Chapter 21, Factors Influencing Health Status and Contact with Health ServicesZ30 Encounter for contraceptive managementZ31 Encounter for procreative managementZ32 Encounter for pregnancy test and childbirth and childcare instructionZ33 Pregnant state

2013 2013Z33.1, one of my favorite codes..20Coding Conditions for ICD-10-CM Chapter 15

Pregnancy-Related Codes in Chapter 21, Factors Influencing Health Status and Contact with Health Services (continued)Z34 Encounter for supervision of normal pregnancyZ36 Encounter for antenatal screening of motherZ3A Weeks of GestationThe weeks of gestation indicate the length of the pregnancy measured in completed weeksThis code is used in addition to a code from Chapter 15

2013 2013Coding Conditions for ICD-10-CM Chapter 15

Pregnancy-Related Codes in Chapter 21, Factors Influencing Health Status and Contact with Health Services (continued)Z34 Encounter for supervision of normal pregnancyZ36 Encounter for antenatal screening of motherZ3A Weeks of GestationThe weeks of gestation indicate the length of the pregnancy measured in completed weeksThis code is used in addition to a code from Chapter 15

2013 2013Coding Conditions for ICD-10-CM Chapter 15

Pregnancy-Related Codes in Chapter 21, Factors Influencing Health Status and Contact with Health Services (continued)Z37 Outcome of deliveryCodes used as an additional code to identify the outcome of delivery on the mothers records, to identify the status of the infant as single, twin, or other multiple birth, and whether the infant was liveborn or stillbornZ39 Encounter for maternal postpartum care and examination 2013 2013Z37 on the moms record and never as principal. We will see how that differs for the babys record in the next chapter.23Coding Conditions for ICD-10-CM Chapter 15

Pregnancy with Abortive Outcome (O00O08)Pregnancies that end before the completion of 20 weeks of gestationEctopic pregnancy (O00)Fourth digit identifies the site: abdominal, tubal, ovarian, otherUse additional code to identify any associated complicationMissed abortion (O02.1)Early fetal death before completion of 20 weeks of gestation with retention of dead fetus 2013 2013Now the book takes you through the codes in th chapter..24Coding Conditions for ICD-10-CM Chapter 15

Pregnancy with Abortive Outcome (O00O08)Spontaneous abortion (O03)Expulsion or extraction from the uterus of all or part of the products of conception: a embryo or a nonviable fetus weighing less than 500 gramsIf weight cannot be determined, an estimated gestation of less than 20 completed weeks is considered an abortionFourth characters used indicate the presence or absence of a complicationDefinitions of complete versus incomplete abortion 2013 2013Coding Conditions for ICD-10-CM Chapter 15

Complications Following (induced) Termination of Pregnancy (O04)Codes used when a complication occurs after the abortion itself was completed during a previous admissionExcludes1 note state these codes are not used during an encounter for elective termination of pregnancy that is uncomplicated or during an encounter when a failed attempted termination of pregnancy occursFourth-digit code identifies the specific complication 2013 2013Coding Conditions for ICD-10-CM Chapter 15

Failed Attempted Termination of Pregnancy (O07)Codes used when an attempted abortion fails and the pregnancy continuesThe failed termination may not produce any complicationOther fourth-character subcategories are used when a complication occursExcludes1 note with O07 codes states that these codes are not used during an encounter for treatment of an incomplete spontaneous abortions 2013 2013Coding Conditions for ICD-10-CM Chapter 15

Complications Following Ectopic and Molar Pregnancy (O08)Codes used when a complication occurs with an ectopic and molar pregnancyCategory O08 is used with categories O00O02 to identify any associated complication with the specific conditions included in the fourth-digit level of O08 2013 2013Coding Conditions for ICD-10-CM Chapter 15

Supervision of High Risk Pregnancy (O09)Codes may be used as principal, first-listed or as an additional diagnosis codeAnother code from chapter 15 may be used with code from category O09Sixth-character level identifies the trimester of pregnancy when the supervision occurredMain term Pregnancy, supervision (of)(for) in Alphabetic Index 2013 2013Coding Conditions for ICD-10-CM Chapter 15

Threatened Abortion (O20.0)Characterized by bleeding of intrauterine origin before the 20th completed week of gestation, without expulsion of the products of conception and without dilation of the cervixLoss of the pregnancy is prevented and the patient remains pregnant at the end of the admission or encounter 2013 2013Coding Conditions for ICD-10-CM Chapter 15

Recurrent Pregnancy loss (O26.20O26.23, N96)Also known as habitual or recurrent abortionDefines the spontaneous expulsion of a dead or nonviable fetus in two or more pregnancies at any gestational ageCoding guidelines when to use codesN96 is used if the current hospital admission or encounter does not involve a pregnancy (in the patient) but rather care of a nonpregnant woman with a history of recurrent pregnancy loss 2013 2013Coding Conditions for ICD-10-CM Chapter 15

PregnancyState of a female after conception until birth (delivery) of the childNormal duration about 266 daysPreterm delivery: before 37 completed weeksTerm delivery: between 38 and 40 completed weeksPostterm delivery: between 41 and 42 completed wksProlonged: pregnancy advanced beyond 42 completed weeksPostpartum or puerperium begins immediately after delivery and continues for 6 weeks 2013 2013Coding Conditions for ICD-10-CM Chapter 15

Encounter for Delivery (O80O82)Category O80 is used when the pregnant female has aFull term single live-born infantSpontaneous, cephalic, vaginal deliveryDelivery requiring minimal or no assistance, with or without episotomy, without fetal manipulation (that is, rotation version) or instrumentation (forceps)Used as a single code, not used with any other code from Chapter 15Must be accompanied by appropriate procedure codeAdditional code to indicate the outcome of delivery, Z37 category code 2013 2013Strict criteria for when a O80 can be assigned. Review this information carefully. A twin birth, for eg can not be coded here. Neither can a VBAC as there is a uterine scar33Coding Conditions for ICD-10-CM Chapter 15

Encounter for Delivery (O80O82)Category O82 Encounter for Cesarean Delivery without IndicationPregnant female has a cesarean delivery without an indication or the reason for the cesarean delivery documented in the health recordsNot the preferred diagnosis for all encounters for a cesarean delivery Instead, code the reason for the cesarean documented in the heath recordUse Additional code from Z37 to identify the outcome of delivery

2013 2013Coding Conditions for ICD-10-CM Chapter 15

Outcome of Delivery (Z codes)A code from category Z37, Outcome of delivery, is used on every maternal record when a delivery occursZ37 is always an additional diagnosis code to identify the number and status of babies deliveredMain term in the Alphabetic Index to Diseases and Injuries is Outcome of delivery 2013 2013Coding Conditions for ICD-10-CM Chapter 15

Obstetrical and Nonobstetrical ComplicationsMany preexisting conditions, including diabetes, hypertenion, and anemia, may affect or complicate the pregnancy or its managementPregnancy may aggravate the preexisting conditionExamples of complications areEdema, proteinuria and hypertensive disordersMaternal care related to fetus and amniotic cavityComplications of labor and deliveryComplications predominantly related to the puerperium 2013 2013Coding Conditions for ICD-10-CM Chapter 15

Preexisting Hypertenion (O10)Category O10, Preexisting hypertension complicating pregnancy, childbirth and the puerperium provides specific subcategories for the type of hypertensive diseaseEssential hypertensionHypertensive heart diseseHypertensive chronic kidney diseaseHypertensive heart and chronic kidney diseaseSecondary hypertensionUnspecified hypertension

2013 2013Coding Conditions for ICD-10-CM Chapter 15

Other Forms of Hypertension, Pre-eclampsia and Eclampsia (O11O16)Includes other forms of hypertensive disease such asPreexisting hypertension with pre-eclampsiaGestational edema and proteinuria without hypertensionGestational hypertension without significant proteinuriaPre-eclampsiaEclampsiaUnspecified maternal hypertension

2013 2013Coding Conditions for ICD-10-CM Chapter 15

Excessive Vomiting in Pregnancy (O21)Hyperemesis is excessive vomitigHyperemesis gravidarum is severe morning sicknessThese codes do not require an additional code:Mild hyperemesis gravidarumHyperemesis gravidarum with metabolic disturbanceLate vomiting of pregancyVomiting of pregnancy, unspecified

2013 2013Coding Conditions for ICD-10-CM Chapter 15

Late Pregnancy (O48)Two codes exist to identify a woman who is beyond 40 completed weeks of gestation as the primary reason for the obstetrical services renderedWomen are potentially high risk for complicationsO48.0 is post-term pregnancy or pregnancy over 40 completed weeks to 42 completed weeks of gestationO48.1 is prolonged pregnancy or pregnancy that has advanced beyond 42 completed weeks of gestation

2013 2013Coding Conditions for ICD-10-CM Chapter 15

Preterm Labor with or without Delivery (O60)Onset (spontaneous) of labor before 37 completed weeks of gestationEven when delivery of liveborn infant occurs as the result of an attempted elective delivery, it is preterm labor with delivery and not an abortion. Requires the use of outcome of delivery code Z37 with O60One patient cannot have both the diagnosis code for an early onset of delivery (O60) and an elective abortion (Z33.2) on the record. If a woman delivers a liveborn infant at any time before 37 completed weeks of gestation, it would not be abortion, but instead coded as an early onset of delivery (O60). If pregnancy ends before 20 completed weeks as result of elective abortion and there is a nonviable infant, code is Z33.2

2013 2013Coding Conditions for ICD-10-CM Chapter 15

Puerperal Sepsis (O85) and Other Puerperal Infection (O86)Puerperal sepsis (O85) is one of the most serious manifestations of major postpartum infectionComplication occurs during the 6 weeks or 42 days following deliveryCoder uses additional code to identify the known infectious agent (B95B97)Additional code is used if severe sepsis is present with or without shockOther puerperal infection (O86) identifies localized infections that occur during the postpartum period such asInfection of obstetric surgical woundOther infection of the genital tractUrinary tract infection, and other conditions

2013 2013Exercises

Practice coding the conditions included in Chapter 15 of ICD-10-CM for pregnancy, childbirth and the puerperium as well as the procedures related to these conditions by completing the review exercises for Chapter 18.

2013 2013