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CODING ALERT

“O” is for obstetrics: coding for pregnancy and childbirth

By Judy Monestime  bio

ICD-10 CM’s Chapter 15, Pregnancy, Childbirth, and the Puerperium are in the range of O00 (letter O, digit zero, digit zero) to O9A, an interesting coding coincidence given these letters “O” codes are for Obstetrics.

Chapter 15 of ICD-10-CM includes categories O00-O9A arranged in the following blocks:

O00-O08 Pregnancy with abortive outcome
O09- Supervision of high risk pregnancy
O10-O16 Edema, proteinuria and hypertensive disorders in pregnancy, childbirth and the puerperium
O20-O29 Other maternal disorders predominantly related to pregnancy
O30-O48 Maternal care related to the fetus and amniotic cavity and possible delivery problems
O60-O77 Complications of labor and delivery
O80-O82 Encounter for delivery
O85-O92 Complications predominantly related to the puerperium
O94-O9A Other obstetric conditions, not elsewhere classified

 

As instructed by the ICD-10, Coding Guideline, Chapter 15 codes are to be used only on the maternal record, never on the record of the newborn.

Episode of care is eliminated in ICD-10; instead, pregnancy codes have a final character indicating the trimester for the current encounter. Assignment of the final character for trimester should be based on the provider’s documentation of the trimester (or number of weeks) for the current admission/encounter. Whenever 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. The timeframes for the trimesters are as follow:

  • 1st Trimester: less than 14 weeks 0 days
  • 2nd Trimester: 14 weeks 0 days to less than 28 weeks 0 days
  • 3rd Trimester: 28 weeks 0 days until delivery

Code titles have been revised in a number of locations in Chapter 15. For instance, ICD-9 CM’s terminology states the indication for care such as inlet contractions of pelvis (653.2). ICD-10 CM terminology is much more descriptive of what the code represents, that is, maternal care for disproportion due to inlet contractions of pelvis (033.2).

Other examples of title changes:

ICD-9-CM 654, Abnormality of organs and soft tissues of pelvis
ICD-10-CM O34, Maternal care for abnormality of pelvic organs
ICD-9-CM 664, Trauma to perineum and vulva during delivery
ICD-10-CM O70, Perineal laceration during delivery

 

Certain codes in Chapter 15 require a seventh character to identify the fetus in a multiple gestation that is affected by the condition being coded. The applicable seventh characters are:

0    not applicable or unspecified

1    fetus 1

2    fetus 2

3    fetus 3

4    fetus 4

5    fetus 5

9    other fetus

Outcome of delivery codes (Z37.-Z37.9), should be included on every maternal record when a delivery has occurred. These codes are not to be used on subsequent records or on the newborn record. These codes exclude stillborn (P95).

Let’s practice! How do you code the following encounter?

A 37-year-old female. Pregnancy delivered, single liveborn, vaginal delivery, following prolonged second stage of labor. Patient is 39-weeks’ gestation.

O63.1 – Prolonged second stage of labor
O09.523 – Supervision of elderly multigravida, third trimester
Z3A.39 – 39 weeks gestation of pregnancy
Z37.0 – Single live birth

Rationale: When a delivery occurs, the principal diagnosis should correspond to the main circumstances or complication of the delivery. In cases of cesarean delivery, the selection of the principal diagnosis should be the condition established after study that was responsible for the patient’s admission. If the patient was admitted with a condition that resulted in the performance of a cesarean procedure, that condition should be selected as the principal diagnosis. If the reason for the admission/encounter was unrelated to the condition resulting in the cesarean delivery, the condition related to the reason for the admission/encounter should be selected as the principal diagnosis.

A code from category Z37, Outcome of delivery, should be included on every maternal record when a delivery has occurred.

Judy Monestime, MBA, CDIP, CPC, is an AHIMA-approved ICD-10-CM/PCS trainer.

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