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Anatomy and

Pathophysiology
for

ICD-10

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Module 13
system or transmitted in any form or by any means (graphically, electronically, or mechanically, including photocopying, recording, or
Pregnancy .
. . . . .written
. . . . . . permission
. . . . . . . . . .from
. . . . AAPC
. . . . . .and
. . . .the
. . .sources
. . . . . .contained
. . . . . . . . .within.
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
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the expressed
This manual may
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Terminology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
and the sources contained within. No part of this publication covered by the copyright herein may be reproduced, stored in a retrieval
Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
system or transmitted in any form or by any means (graphically, electronically, or mechanically, including photocopying, recording, or
Diseases and Disorders in Pregnancy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7
taping) without the expressed written permission from AAPC and the sources contained within.
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Disclaimer

Contents

ii

Anatomy and Pathophysiology for ICD-10

2012 AAPC. All rights reserved.


011912

Module

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and the sources contained within. No part of this publication covered by the copyright herein may be reproduced, stored in a retrieval
system or transmitted in any form or by any means (graphically, electronically, or mechanically, including photocopying, recording, or
taping) without the expressed written permission from AAPC and the sources contained within.
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and the sources contained within. No part of this publication covered by the copyright herein may be reproduced, stored in a retrieval
system or transmitted in any form or by any means (graphically, electronically, or mechanically, including photocopying, recording, or
of menses.
taping)AmenorrheaAbsence
without the expressed written
permission from AAPC and the sources contained within.
This manual may not be copied, reproduced, dismantled, quoted, or presented without the expressed written approval of the AAPC
fluidLiquid
(andpublication
contained covered by the copyright herein may be reproduced, stored in a retrieval
and theAmniotoic
sources contained
within.produced
No part by
of this
the fetalinmembranes
systemwithin)
or transmitted
any form orduring
by anypregnancy.
means (graphically, electronically, or mechanically, including photocopying, recording, or
taping)Cesarean
without the
expressed
written
permission
from
sectionSurgical procedure where
theAAPC
baby and the sources contained within.
This manual
may
not
be
copied,
reproduced,
dismantled,
quoted, or presented without the expressed written approval of the AAPC
is delivered transabdominally.
and the sources contained within. No part of this publication covered by the copyright herein may be reproduced, stored in a retrieval
systemEclampsiaMost
or transmitted in any
form
or by
any means (graphically,
electronically, or mechanically, including photocopying, recording, or
severe
form
of hypertension
during
taping)pregnancy.
without the expressed written permission from AAPC and the sources contained within.
This manual may not be copied, reproduced, dismantled, quoted, or presented without the expressed written approval of the AAPC
datewithin.
of delivery.
and theEDDExpected
sources contained
No part of this publication covered by the copyright herein may be reproduced, stored in a retrieval
system or transmitted in any form or by any means (graphically, electronically, or mechanically, including photocopying, recording, or
EmbryoName given to product of conception from
taping) without the expressed written permission from AAPC and the sources contained within.
the second through eighth week of pregnancy.
This manual may not be copied, reproduced, dismantled, quoted, or presented without the expressed written approval of the AAPC
and theEndometriumInner
sources contained within.
Noofpart
this publication covered by the copyright herein may be reproduced, stored in a retrieval
lining
the of
uterus.
system or transmitted in any form or by any means (graphically, electronically,
or mechanically, including photocopying, recording, or
Amniotic
taping)LMPLast
without themenstrual
expressedperiod.
written permission from AAPC and the sources space
contained within.
This manual may not be copied, reproduced, dismantled, quoted, or presented without the expressed written approval of the AAPC
OvumFemale sex cell.
and the sources contained within. No part of this publication covered by the copyright herein may be reproduced, stored in a retrieval
systemUmbilical
or transmitted
in any form
by anytomeans
(graphically, electronically, or mechanically, including photocopying, recording, or
cordServes
as aorlifeline
the fetus.
taping) without the expressed written permission from AAPC and the sources contained within.
Copyright
Ingenix. All rights
reserved
ZygoteFertilized
ovum.reproduced, dismantled, quoted, or presented without
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Course
of Pregnancy
taping) without the expressed written permission from AAPC and the
sources contained
within.
Pregnancy
starts
fertilization
anddismantled,
ends with childThis manual
may not
be with
copied,
reproduced,
quoted, or A
presented
expressediswritten
of the AAPC
scientificwithout
term forthe
pregnancy
gravid, approval
thus referring
in an
average span
of 38
the gesta-covered by the copyright herein may be reproduced, stored in a retrieval
and thebirth
sources
contained
within.
Noweeks.
part ofDuring
this publication
to a pregnant female as gravida. The term parity (used
period theinzygote
divides
it passes
systemtional
or transmitted
any form
or byasany
meansthrough
(graphically, electronically,
or mechanically,
including
photocopying,
as para) is used
for the number
of previous
successful recording, or
fallopian
tube and attaches
the uterine
lining
via and the sources contained within.
taping)the
without
the expressed
written to
permission
from
AAPC
live births. So, a woman currently pregnant with her
implantation.
complex
sequences
of developThis manual
may notThrough
be copied,
reproduced,
dismantled,
quoted, or third
presented
written approval
of the AAPC
baby without
with twothe
liveexpressed
births previously
is considered
ment
the
zygote
is
transformed
into
a
full-term
fetus. covered by the copyright herein may be reproduced, stored in a retrieval
and the sources contained within. No part of this publication
Gravida 3 Para 2. Other pregnancy terms:
system or transmitted in any form or by any means (graphically, electronically, or mechanically, including photocopying, recording, or
NulligravidaA
woman who has never been
taping) without the expressed written permission from AAPC and the sources
contained within.
pregnant
(also
called
nulliparous)
This manual may not be copied, reproduced, dismantled, quoted, or presented without the expressed
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woman
for thestored
first time
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the copyright herein
maypregnant
be reproduced,
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MultigravidaA
womanincluding
in a subsequent
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contained
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(also called multiparous)
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AbortionDeath of embryo or fetus whether
and the sources contained within. No part of this publication covered by the copyright herein may be reproduced, stored in a retrieval
spontaneous or induced
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Pregnancy

13

Terminology

Introduction

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Pregnancy

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contained
The course
of pregnancy
is usually
broken
down
intoand the sources
sickness,
womenwithin.
can experience this nausea during
This manual
may not be
copied, reproduced,
dismantled,
or presented
without
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writtenthe
approval
the AAPC
trimesters.
According
to ICD-10-CM
the breakquoted,
down for
afternoon,
evening,
and throughout
entire of
day.
and the sources
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within.
No
part
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may
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the trimesters are:
In the first
12 weeks of pregnancy,
nipples andrecording, or
system or transmitted in any form or by any means (graphically, electronically,
or mechanically,
including the
photocopying,
1st
thanpermission
14 weeks 0from
days AAPC and the sources
areolascontained
darken due
to a temporary increase in hormones.
taping) without
thetrimesterless
expressed written
within.
The
first
two
weeks
from the first
trimester
areof
calcuThis manual may
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the AAPC
2ndnot
trimester14
weeks 0 days
to less thanquoted,
28
as the firstherein
two weeks
of reproduced,
pregnancy even
though
and the sourcesweeks
contained
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may be
stored
in a retrieval
0 dayswithin. No part of this publication covered bylated
the pregnancy
does not actually
exist.
These two weeks
system or transmitted in any form or by any means (graphically, electronically,
or mechanically,
including
photocopying,
recording, or
3rd trimester28 weeks 0 days until delivery
are thecontained
two weekswithin.
before conception and include the
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womans
last period.
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First
Trimester
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Traditionally,
have
measured
pregnancy
from electronically,
The third
is the week
in whichphotocopying,
fertilization occurs
system or transmitted
in doctors
any form
or by
any means
(graphically,
or week
mechanically,
including
recording, or
a
number
of
convenient
points,
including
the
day
of
and
the
fourth
week
is
the
period
when
implantation
taping) without the expressed written permission from AAPC and the sources contained within.
lastmay
menstruation,
ovulation,
fertilization,
implantatakes place.
In the
week,
the fecundated
This manual
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the fourth
expressed
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tion, and
chemical
detection.
In of
medicine,
pregnancy
is byreaches
the uterus
andmay
burrows
into its wallstored
whichin a retrieval
and the sources
contained
within.
No part
this publication
covered
the copyright
herein
be reproduced,
often defined
beginning
when
developing
embryo
providesoritmechanically,
with the nutrients
it needs.
At this point,
the
system or transmitted
inas
any
form or by
anythe
means
(graphically,
electronically,
including
photocopying,
recording,
or
becomes
implanted
into
the
endometrial
lining
of
a
zygote
becomes
a
blastocyst
and
the
placenta
starts
to
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womans
Mostreproduced,
pregnant women
do not quoted,
have anyor presented
form. Moreover,
most
of the pregnancy
tests may
detect
This manual
may notuterus.
be copied,
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specific
signs or within.
symptoms
implantation,
although
pregnancy
beginning
with
week. stored in a retrieval
and the sources
contained
No of
part
of this publication
covered byathe
copyright
herein may
bethis
reproduced,
it is not uncommon
to experience
minimal
bleeding electronically, or mechanically, including photocopying, recording, or
system or transmitted
in any form
or by any means
(graphically,
The fifth week marks the start of the embryonic period.
at
implantation.
Some
women
will
also
experience
taping) without the expressed written permission from AAPC and the sources
within.brain, spinal cord, heart and
This is contained
when the babys
cramping
during
their
first
trimester.
This
is
usually
This manual may not be copied, reproduced, dismantled, quoted, or presented
withoutbegin
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organs
to form. At
this point
the embryo
is
of no contained
concern unless
there
spotting
bleeding ascovered byother
and the sources
within.
No ispart
of thisorpublication
the
copyright
herein
may
be
reproduced,
stored
in athe
retrieval
made
up
of
three
layers,
of
which
the
top
one
(called
well. After implantation
thebyuterine
endometrium
is electronically, or mechanically, including photocopying, recording, or
system or transmitted
in any form or
any means
(graphically,
ectoderm) will give rise to the babys outermost layer of
calledthe
theexpressed
decidua. The
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whichfrom
is formed
partly
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and
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of
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This manual may not be copied, reproduced, dismantled, quoted, or presented
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ofthe
the AAPC
ear, andwithout
many connective
tissues.
Theapproval
heart and
embryo,
connects
the developing
the uterine
and the sources
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this to
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covered bybeginning
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herein
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of the circulatory system as well as thein
bones,
wall to allowinnutrient
uptake,
waste
elimination,
and gas
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means
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electronically,
or
mechanically,
including
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or
muscles and kidneys are made up from the mesoderm
exchange
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supply.from
The umbilical
taping) without
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(the middle layer). The inner layer of the embryo will
cord
is not
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cord from the
embryo orquoted,
fetus toor presented
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serve aswithout
the starting
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the development
ofthe
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the placenta.
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tremenand the sources
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No part
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the copyright
herein
may
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stored
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a retrieval
intestine and bladder. This layer is referred
dous growthinand
process
of fetal electronically,lungs,
system or transmitted
anychanges
form orduring
by any the
means
(graphically,
or
mechanically,
including
photocopying,
recording,
or
to as the endoderm. A baby at five weeks is normally
development.
taping) without
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contained
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between 116 and 18 inch (1.6 and 3.2 mm) in length.
This manual
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In some cases a complication may occur where the fertiland the sources
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covered
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maywill
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reproduced,
a retrieval
In
the
6th
week,herein
the baby
developingstored
basic in
facial
ized egg might implant itself in the fallopian tubes, the
system or transmitted
in
any
form
or
by
any
means
(graphically,
electronically,
or
mechanically,
including
photocopying,
recording,
or
features
and
its
arms
and
legs
start
to
grow.
At
this
point,
cervix, and the ovaryor in the abdomen, causing an
taping) without
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the
embryo
is
usually
no
longer
than
16
to
14
inch
(4.2
ectopic pregnancy. In the case of an ectopic pregnancy
This manual
mayisnot
dismantled,
quoted, or presented
without
the following
expressedweek,
written
of the
AAPC
to 6.3 mm).
In the
theapproval
brain, face,
arms,
there
no be
waycopied,
for thereproduced,
pregnancy to
progress normally.
and the sources
contained
within.
No
part
of
this
publication
covered
by
the
copyright
herein
may
be
reproduced,
stored
in
a
retrieval
and
legs
quickly
develop.
In
the
8th
week,
the
baby
starts
If left untreated, it can cause harm and possibly death
system or transmitted
in
any
form
or
by
any
means
(graphically,
electronically,
or
mechanically,
including
photocopying,
recording,
or
moving
and
in
the
next
three
weeks,
the
babys
toes,
for the mother when a rupture occurs. It may go away on
taping) without
the
expressed
written
permission
from
AAPC
and
the
sources
contained
within.
neck,
and
genitals
develop
as
well.
By
the
end
of
the
first
its own, or it may need surgical removal or medicine to
This manual
may not
copied,
reproduced,
dismantled,
quoted,
without
the expressed
written
approval
of the
AAPC
trimester,
the fetus
will be about
3 inches
(76 mm)
long
remove
thebe
tubal
pregnancy
since there
is no way
of theor presented
and the sources
contained
within.
No
part
of
this
publication
covered
by
the
copyright
herein
may
be
reproduced,
stored
in
a
retrieval
and
will
weigh
approximately
1
ounce
(28
g).
pregnancy being able to continue safely.
system or transmitted in any form or by any means (graphically, electronically, or mechanically, including photocopying, recording, or
A common
occurrence
in pregnancy
morning
sicktaping) without
the expressed
written
permissionis from
AAPC
and the sources
contained
within.
Second
Trimester
ness.
percentreproduced,
of all pregnant
women will
This manual
mayAbout
not be70copied,
dismantled,
quoted, or presented
withoutfeel
themore
expressed
written
approval
the AAPC
Most women
energized
in the
secondoftrimester
encounter
this condition
and
it typically
improves after
and the sources
contained
within. No
part
of this publication
covered byand
thebegin
copyright
herein
may
be
reproduced,
stored
in a retrieval
to put on weight as the symptoms of morning
the first trimester.
as(graphically,
morning electronically,
system or transmitted
in any Although
form or bydescribed
any means
or
mechanically,
including
photocopying,
recording, or
sickness subside and eventually fade away. In the 20th
taping) without the expressed written permission from AAPC and the sources contained within.

Anatomy and Pathophysiology for ICD-10

2012 AAPC. All rights reserved.


011912

Module 13

Pregnancy

This manual may not be copied, reproduced, dismantled, quoted, or presented without the expressed written approval of the AAPC
and the sources contained within. No part of this publication covered by the copyright herein may be reproduced, stored in a retrieval
system or transmitted in any form or by any means (graphically, electronically, or mechanically, including photocopying, recording, or
taping)week
without
the expressed
written
permission
from
AAPC and the sources
contained
within. that is caused by decreased
the uterus
can expand
up to
20 times its
normal
Constipation.
A complaint
This manual
may not
be copied,
dismantled,
quoted, or presented
without the
expressed
writtenprogesterone
approval of the AAPC
size during
pregnancy.
In reproduced,
the second trimester
quickbowel mobility
secondary
to elevated
and theening
sources
contained
within.
No
part
of
this
publication
covered
by
the
copyright
herein
may
be
reproduced,
stored in a retrieval
occurs, when movement of the fetus is finally
which can lead to greater absorption of water.
systemfelt.
or transmitted
in happens
any forminorthe
by fourth
any means
(graphically,
electronically,
mechanically,
including
photocopying,
This typically
month,
more
BraxtonorHicks
contractions.
Occasional,
irregular,recording, or
taping)specifically
without theinexpressed
written
permission
from
contained
within.
the 20th to
21st week,
or by the
19thAAPC
week and the sources
and often painless contractions that occur several
This manual
may nothas
be been
copied,
reproduced,
without
if the woman
pregnant
before.dismantled,
However, itquoted,
is not or presented
times per
day. the expressed written approval of the AAPC
and theuncommon
sources contained
within.
No
part
of
this
publication
covered
by
the
copyright
herein may be reproduced, stored in a retrieval
for some women not to feel the fetus move
Edema. Common complaint in advancing
systemuntil
or transmitted
anyplacenta
form orfully
by any
means (graphically,
much later.inThe
functions
at this time electronically, or mechanically, including photocopying, recording, or
pregnancy. Caused by compression of the inferior
taping)and
without
the expressed
written
from
AAPC and the sources contained within.
the fetus
makes insulin
andpermission
urinates. The
reproducvena cava (IVC) and pelvic veins by the uterus
This manual
may not
be copied,
dismantled,
tive organs
distinguish
thereproduced,
fetus as male
or female. quoted, or presented without the expressed written approval of the AAPC
leads to increased hydrostatic pressure in lower
and the sources contained within. No part of this publication covered by the copyright herein may be reproduced, stored in a retrieval
extremities.
systemThird
or transmitted
in any form or by any means (graphically, electronically, or mechanically, including photocopying, recording, or
Trimester
Regurgitation,
heartburn,
taping)Final
without
the gain
expressed
writtenwhich
permission
fromweight
AAPC and the sources
contained
within. and nausea. May be
weight
takes place,
is the most
caused
by
Gastroesophageal
(GERD).
This manual
may not bethe
copied,
reproduced,
dismantled,
quoted, or presented without the expressed Reflux
writtenDisease
approval
of the AAPC
gain throughout
pregnancy.
The fetus
will be growing

Hemorrhoids.
Complaint
that
is
often
noted
in
and thethe
sources
contained
within.
No
part
of
this
publication
covered
by
the
copyright
herein
may
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stored
in a retrieval
most rapidly during this stage, gaining up to 28 g per
advancing
pregnancy. Caused
by increased
venousrecording, or
systemday.
or transmitted
in belly
any form
or by any means
or mechanically,
including
photocopying,
The womans
will transform
in shape(graphically,
and her electronically,
stasis
and
IVC
compression
leading
to
congestion
taping)belly
without
the
expressed
written
permission
from
AAPC
and
the
sources
contained
within.
will drop because the fetus is turning in a downin venous
system,
withwritten
increased
abdominal
This manual
may nottobeget
copied,
without
the along
expressed
approval
of the AAPC
ward position
readyreproduced,
for birth. Thedismantled,
fetus beginsquoted, or presented
pressure
secondary
to
the
pregnant
space-occupying
and thetosources
contained
within.
No
part
of
this
publication
covered
by
the
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herein
may
be
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stored
in a retrieval
move regularly, and can be felt often by the woman.
uterus and
constipation.including photocopying, recording, or
systemFetal
or transmitted
any
form or
by any
means
(graphically,
electronically,
or mechanically,
movementin
can
become
quite
strong
at this
point.
taping)Sometimes
without thethe
expressed
written
permission
from
AAPC
and
the
sources
contained
Pelvic girdle painwithin.
(PGP). This disorder is complex
womans navel will pop out and become
This manual
may
not
be
copied,
reproduced,
dismantled,
quoted,
or
presented
without the expressed
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the AAPC
and multi-factorial
and likelywritten
to be represented
convex. This period of her pregnancy can be uncomfortand theable
sources
contained
within.
No
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of
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publication
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by
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herein
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be
reproduced,
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a series of sub-groups with different underlying in a retrieval
due to: symptoms such as weak bladder control and
systembackache,
or transmitted
anyfetus
formrolling
or by any
meanspain
(graphically,
electronically,
or mechanically,
including
photocopying, recording, or
pain drivers.
Musculo-Skeletal
Mechanics
feelinginthe
causing
and
taping)discomfort
without theif expressed
written
permission
from
AAPC
and
the
sources
contained
within.
involved in gait and weight-bearing activities
the is near the womans ribs or spine.
This manual may not be copied, reproduced, dismantled, quoted, or presented
expressed
written
of the AAPC
can bewithout
mild to the
grossly
impaired.
PGPapproval
can begin
fetuscontained
movementwithin.
becomes
and publication
more
and theThe
sources
Nostronger
part of this
covered byperi
the copyright
herein
may
be
reproduced,
stored
or postpartum. There is pain, instability, in a retrieval
due to improved
eye,
muscle
systemfrequent
or transmitted
in any form
orbrain,
by anyand
means
(graphically, electronically,
or mechanically,
includingpubis
photocopying,
recording, or
or dysfunction
in the symphysis
and/or
Head
engagement
occurs
when thefrom
fetalAAPC
head and the sources
taping)function.
without the
expressed
written
permission
contained
within.
sacroiliac joints.
descends
This is termed
as thequoted,
baby or presented without the expressed written approval of the AAPC
This manual
mayinto
notthe
be pelvic
copied,cavity.
reproduced,
dismantled,
Round Ligament Pain. Pain experienced when the
or the lightening.
severely
reducescovered by the copyright herein may be reproduced, stored in a retrieval
and thedropping
sources contained
within. However,
No part ofitthis
publication
ligaments positioned under the uterus stretch and
capacityinand
on the(graphically,
pelvic
systembladder
or transmitted
anyincreases
form or pressure
by any means
electronically, or mechanically, including photocopying, recording, or
expand to support the womans growing uterus.
and the expressed
rectum. This
sometimes
causesfrom
the mother
taping)floor
without
written
permission
AAPC and the sources contained within.
Thromboembolic
leading
cause ofof the AAPC
to experience
sensation that
the fetus quoted,
will
This manual
may notthe
be perpetual
copied, reproduced,
dismantled,
or presented
without thedisorders.
expressed A
written
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death
in
pregnant
women.
out contained
at any moment.
The
andpublication
cervix are covered by the copyright herein may be reproduced, stored in a retrieval
and thefall
sources
within.
Noperineum
part of this
Increased
urinary frequency.
Caused
by increasedrecording, or
flattenedinand
head
be felt
vaginally.
systemfurther
or transmitted
anythe
form
ormay
by any
means
(graphically, electronically,
or mechanically,
including
photocopying,
intravascular
volume,
elevated GFR (glomerular
taping) without the expressed written permission from AAPC and the sources
contained
within.
filtration
rate), the
andexpressed
compression
of the
bladderofbythe AAPC
This manual
may not be copied,
reproduced, dismantled, quoted, or presented
without
written
approval
Complications
of Pregnancy
the
expanding
uterus.
and thePregnancy
sources contained
within.
No
part
of
this
publication
covered
by
the
copyright
herein
may
be
reproduced,
stored in a retrieval
poses varying levels of health risks for women,
systemdepending
or transmitted
in any
form profile
or by any
means
(graphically, electronically,
mechanically,
Urinaryortract
infection including photocopying, recording, or
on their
medical
before
pregnancy.
taping) without the expressed written permission from AAPC and the sources
contained
within.by relaxation of the venous
Varicose veins. Caused
The following
some ofreproduced,
the complaints
that may quoted,
occur or presented without the expressed written approval of the AAPC
This manual
may notare
be copied,
dismantled,
smooth muscle and increased intravascular pressure.
and/or
after pregnancy
changescovered by the copyright herein may be reproduced, stored in a retrieval
and theduring
sources
contained
within. No due
parttoofthe
thismany
publication
Pruritic Urticarial Papules and Plaques of Pregnancy
pregnancy
in aorwomans
body: (graphically, electronically,
systemwhich
or transmitted
incauses
any form
by any means
or mechanically, including photocopying, recording, or
(PUPPP). This is a skin disease that develops around
taping) without the expressed written permission from AAPC and the sources contained within.
Anemia
the 32nd week with itchiness around the belly button
This manual may not be copied, reproduced, dismantled, quoted, or presented without the expressed written approval of the AAPC
and red plaques and papules that spread all over the
Back contained
pain. A common
thepublication
third trimesand the
sources
within.complaint
No part ofinthis
covered by the copyright herein may be reproduced, stored in a retrieval
body except for the inside of the hands and face.
ter when theinpatients
center
gravity
has(graphically,
shifted.
system or transmitted
any form
or byofany
means
electronically, or mechanically, including photocopying, recording, or
taping) without the expressed written permission from AAPC and the sources contained within.
2012 AAPC. All rights reserved.
011912

www.aapc.com

Pregnancy

Module 13

This manual may not be copied, reproduced, dismantled, quoted, or presented without the expressed written approval of the AAPC
and the sources contained within. No part of this publication covered by the copyright herein may be reproduced, stored in a retrieval
system or transmitted in any form or by any means (graphically, electronically, or mechanically, including photocopying, recording, or
taping) without
the expressed
written permission from AAPC and the sources contained within.
Postpartum
depression
First Stage: Dilation
This manual may not be copied, reproduced, dismantled, quoted, or presented without the expressed written approval of the AAPC
Postpartum psychosis
are several
factors
that
andstored
clinicians
and the sources contained within. No part of this publication covered byThere
the copyright
herein
may
bemidwives
reproduced,
in a retrieval
use
to
assess
the
laboring
mothers
progress,
and these
system or transmitted in any form or by any means (graphically, electronically, or mechanically, including photocopying,
recording, or
Childbirth
are defined
by thewithin.
Bishop Score. The total score is
taping) without
the expressed written permission from AAPC and the sources
contained
achieved
by assessing
the following
components
Childbirth,
orcopied,
labor, birth,
partus, dismantled,
parturition. quoted,
This is or presented
This manual
may not be
reproduced,
without
the expressed
writtenfive
approval
of the on
AAPC
examination:
the end
of the pregnancy
with
of one or more
and the sources
contained
within. No
partthe
of birth
this publication
covered byvaginal
the copyright
herein may be reproduced, stored in a retrieval
newborn infants.
woman
considered
to be in laborelectronically, or mechanically, including photocopying, recording, or
system or transmitted
in anyAform
or byis any
means (graphically,
Cervical dilation
when
she
begins
experiencing
regular
uterine
contractaping) without the expressed written permission from AAPC
and the sources contained within.
Cervical effacement
tions,
changes of her
cervixprimarily
This manual
mayaccompanied
not be copied,byreproduced,
dismantled,
quoted, or presented without the expressed written approval of the AAPC
effacement
and dilation.
Allpart
changes
inpublication
the soft tissues
of by the
Cervical
and the sources
contained
within. No
of this
covered
copyrightconsistency
herein may be reproduced, stored in a retrieval
the
cervix
and
the
birth
canal
depend
on
the
successful
Cervical
position including photocopying, recording, or
system or transmitted in any form or by any means (graphically, electronically,
or mechanically,
completion
of thesewritten
six phases:
taping) without
the expressed
permission from AAPC and the sources
contained
Fetal
station within.
This manual 1.
mayEngagement
not be copied,
reproduced,
quoted, or presented without the expressed written approval of the AAPC
of the
fetal headdismantled,
in the transverse
score
grades
patients
who would
be most
and the sources position.
containedThe
within.
No
part
of
this
publication
covered byThe
theBishop
copyright
herein
may
be reproduced,
stored
in a retrieval
babys head is facing across the pelvis
likely toorachieve
a successful
induction.
Each composystem or transmitted
in
any
form
or
by
any
means
(graphically,
electronically,
mechanically,
including
photocopying,
recording, or
at one or other of the mothers hips.
nent is contained
given a score
of 0-2 or 0-3. The highest possible
taping) without the expressed written permission from AAPC and the sources
within.
score iswithout
13. Thethe
duration
of labor
is inversely
This manual 2.
mayDescent
not be copied,
reproduced,
dismantled,
expressed
written
approvalcorrelated
of the AAPC
and flexion
of the fetal
head. quoted, or presented
with
the
Bishop
score;
a
score
that
exceeds
8 describes
and the sources contained within. No part of this publication covered by the copyright herein may be reproduced, stored
in a retrieval
3. Internal
rotation.
Thebyfetal
rotates
90 degrees
the patient
most likely toincluding
achieve a photocopying,
successful vaginal
system or transmitted
in any
form or
anyhead
means
(graphically,
electronically,
or mechanically,
recording, or
occipito-anterior
position sofrom
thatAAPC
the babys
birth. Bishop
scores
of less than 6 usually require that a
taping) without to
thethe
expressed
written permission
and the sources
contained
within.
mothers rectum.
cervicalwithout
ripening
be used
before
other of
methods.
This manual mayface
notisbetowards
copied,the
reproduced,
dismantled, quoted, or presented
themethod
expressed
written
approval
the AAPC
and the sources contained within. No part of this publication covered by the copyright herein may be reproduced, stored in a retrieval
4. Delivery by extension. The fetal head passes out of
The firstorstage
of labor starts
classically
when the effaced
system or transmitted in any form or by any means (graphically, electronically,
mechanically,
including
photocopying,
recording, or
the birth canal. Its head is tilted backwards so that
cervix
is
3
cm
dilated.
There
is
a
variation
in this point
taping) without the expressed written permission from AAPC and the sources contained within.
its forehead leads the way through the vagina.
as somewithout
womenthe
may
or may not
haveapproval
active contractions
This manual may not be copied, reproduced, dismantled, quoted, or presented
expressed
written
of the AAPC
prior
to
this.
The
onset
of
actual
labor
is defined when
and the sources
contained within.
No part
this through
publication
5. Restitution.
The fetal
headofturns
45 covered by the copyright herein may be reproduced, stored in a retrieval
the cervix begins to progressively dilate, with or without
system or transmitted
formits
or normal
by any means
(graphically,
degreesintoany
restore
relationship
with theelectronically, or mechanically, including photocopying, recording, or
rupturecontained
of the membranes
taping) without shoulders,
the expressed
written
permission
from AAPC and the sources
within. or a blood stained show.
which
are still
at an angle.
This manual may not be copied, reproduced, dismantled, quoted, or presented
expressed
written
approval
of top
the of
AAPC
Uterinewithout
musclesthe
form
opposing
spirals
from the
6. External
Thepart
shoulders
repeat the corkand the sources
containedrotation.
within. No
of this publication
covered bythe
theupper
copyright
herein
may
be
reproduced,
stored
in
a
retrieval
segment of the uterus to its junction with the
screw movements
head,
which(graphically,
can be seenelectronically,
in
system or transmitted
in any form of
orthe
by any
means
or
mechanically,
including
photocopying,
recording,
or
lower segment. During effacement, the cervix becomes
movements
the fetal head.
taping) without the final
expressed
writtenofpermission
from AAPC and the sources
contained
within.
incorporated into the lower segment of the uterus.
This manual may not be copied, reproduced, dismantled, quoted, or presented
the expressed
written contract
approvalcausing
of the AAPC
Duringwithout
a contraction,
these muscles
Latent
Phase
and the sources
contained
within. No part of this publication covered byshortening
the copyright
herein
may
be
reproduced,
stored
in a retrieval
of the upper segment and drawing upwards
system or transmitted
in any
by any means
(graphically,
or
mechanically,
including
photocopying,
recording, or
The latent phase
ofform
laboror(prodromal
labor)
may last electronically,
of the lower segment, in a gradual expulsive motion.
taping) without
expressed
written permission
AAPC and
contained
within.
manythe
days
and the contractions
are an from
intensification
of the sources
This draws the cervix up over the babys head. Full dilaThis manual
not be copied,
reproduced,
dismantled,
quoted, or presented
expressed
written
approvalenough
of the AAPC
themay
Braxton-Hicks
contractions
that
may start around
tion is without
reached the
when
the cervix
has widened
to
and the sources
contained
within.
No part
of this publication
covered byallow
the copyright
herein
may
be
reproduced,
stored
in
a
retrieval
26 weeks
gestation.
Cervical
effacement
occurs during
passage of the babys head, around 10 cm dilation
system or transmitted
in anyof
form
or by any
means
(graphically,
or
mechanically,
including
photocopying,
recording,
or
the closing weeks
pregnancy
and
is usually
completeelectronically,
for a term baby.
taping) without
thecomplete,
expressedbywritten
from
AAPC
or near
the endpermission
of the latent
phase.
Theand the sources contained within.
The duration
labor
varies widely.
phase
arrest
This manual
may not
be copied,
reproduced,
or presented
withoutofthe
expressed
writtenActive
approval
of the
AAPC
degree
of cervical
effacement
may dismantled,
be felt duringquoted,
a
defined
in a primigravida
as the stored
failurein
ofathe
and the sources
contained
within.
part
of this
publication
covered byisthe
copyright
herein may bewoman
reproduced,
retrieval
vaginal
examination.
A No
long
cervix
implies
that not
cervix to
at a rate of
1.2 cm/hr
over a periodrecording,
of at
system or transmitted
in any form
by any
means (graphically,
ordilate
mechanically,
including
photocopying,
or
much has changed
in theorlower
segment,
and vice versaelectronically,
least two
hours. This
definition is based on Friedmans
taping) without
the expressed
writtenphase
permission
fromthe
AAPC
contained
within.
for a short
cervix. Latent
ends with
onsetand
of the sources
Curve,without
which plots
an ideal rate
of cervical
dilation
This manual
mayfirst
not stage;
be copied,
the expressed
written
approval
of theand
AAPC
active
whenreproduced,
the cervix isdismantled,
about 3 cmquoted,
dilated.or presented
descent during
and the sources contained within. No part of this publication covered byfetal
the copyright
hereinactive
may labor.
be reproduced, stored in a retrieval
system or transmitted in any form or by any means (graphically, electronically, or mechanically, including photocopying, recording, or
taping) without the expressed written permission from AAPC and the sources contained within.

Anatomy and Pathophysiology for ICD-10

2012 AAPC. All rights reserved.


011912

Module 13

Pregnancy

This manual may not be copied, reproduced, dismantled, quoted, or presented without the expressed written approval of the AAPC
and the sources contained within. No part of this publication covered by the copyright herein may be reproduced, stored in a retrieval
system or transmitted in any form or by any means (graphically, electronically, or mechanically, including photocopying, recording, or
taping) without the expressed written permission from AAPC and the
sourcesPlacental
contained
within. begins as a physiological
clamped.
expulsion
This manual may not be copied, reproduced, dismantled, quoted, or separation
presented without
the
expressed
written
approval
from
the
wall
of the uterus.
The
placentaofisthe AAPC
Breech
and the sources contained within. No part
of
this
publication
covered
by
the
copyright
herein
may
be
reproduced,
stored
in a retrieval
usually expelled within 1530 minutes of the baby
being
Shoulder
(arm
system or transmitted in any form or by any means (graphically, electronically,
or mechanically,
photocopying,
born. Placental
expulsion canincluding
be managed
actively, forrecording, or
prolapse)
taping) without the expressed written permission
from AAPC and the
sources
within.via intramuscular injecexample
bycontained
giving oxytocin
This manual may not be copied, reproduced, dismantled, quoted, or tion
presented
without
thetraction
expressed
written
the AAPC
followed
by cord
to assist
in approval
deliveringofthe
and the sources contained within. No part of this publication covered
by
the
copyright
herein
may
be
reproduced,
stored
placenta. Alternatively, it can be managed expectantly,in a retrieval
Mother's
system or transmitted in any form or by any means (graphically, electronically,
mechanically,
including
photocopying,
allowing theorplacenta
to be expelled
without
medical recording, or
pelvis
taping) without the expressed written permission from AAPC and the
sources contained within.
assistance.
This manual may not be copied, reproduced, dismantled, quoted, or presented without the expressed written approval of the AAPC
The
codes
formay
pregnancy
can be found
and the sources contained within. No part of this publication covered
byICD-10-CM
the copyright
herein
be reproduced,
storedinin a retrieval
chapter
15,
Pregnancy,
Childbirth
and
the
Puerperium,
Compound
system or transmitted in any form or by any means (graphically, electronically, or mechanically, including photocopying, recording, or
(extremity
O00O9a.
To code this
in ICD-10-CM the following is
taping) without
permission from AAPC and the
sources contained
within.
together
Face the expressed written
necessary:
head)
Oblique
(mentum)
This manual
may not be copied,with
reproduced,
dismantled,
quoted, or presented without the expressed written approval of the AAPC
and the sources contained within. No part of this publication covered by the copyright herein may be reproduced, stored in a retrieval
Trimester
system or transmitted Copyright
in any form
orAllbyrights
anyreserved
means (graphically, electronically, or mechanically, including photocopying, recording, or
Ingenix.
Gestational
condition
or pre-existing
taping) without the expressed written permission from AAPC and the sources
contained
within.
Type ofwithout
complication
This manual may not be copied, reproduced, dismantled, quoted, or presented
the expressed written approval of the AAPC
Second Stage: Fetal Expulsion
and the sources contained within. No part of this publication covered by the copyright herein may be reproduced, stored in a retrieval
Following are
examples of ICD-10-CM
pregnancy codes:
stage beginsinwhen
the cervix
is fully
dilated,
and
systemThis
or transmitted
any form
or by any
means
(graphically,
electronically,
or mechanically,
including photocopying,
recording, or
whenthe
theexpressed
baby is finally
born.
As pressure
the and the sources contained within.
taping)ends
without
written
permission
fromon
AAPC
cervixmay
increases,
Ferguson
reflex increases
uterine
Supervision
of pregnancy
with history
This manual
not bethe
copied,
reproduced,
dismantled,
quoted, or presented
without
the expressed
writtenofapproval of the AAPC
contractions
so
that
the
second
stage
can
go
ahead.
At coveredectopic
or molar pregnancy,
O09.10
and the sources contained within. No part of this publication
by the copyright
herein mayunspecified
be reproduced, stored
in a retrieval
the
beginning
of
the
normal
second
stage,
the
head
is
trimester or mechanically, including photocopying, recording, or
system or transmitted in any form or by any means (graphically, electronically,
engaged
in the pelvis;
the widest
diameter
the and the sources contained within.
taping)fully
without
the expressed
written
permission
fromofAAPC
head has
passed
through the
pelvic brim.
Supervision
of pregnancy
with history
This manual
maysuccessfully
not be copied,
reproduced,
dismantled,
quoted, or presented
without
the expressed
writtenofapproval of the AAPC
O09.11
Ideally
it
has
successfully
also
passed
below
the inter- coveredectopic
or molar pregnancy,
trimester stored in a retrieval
and the sources contained within. No part of this publication
by the copyright
herein mayfirst
be reproduced,
spinous
diameter
which
is
the
narrowest
part
of
the
system or transmitted in any form or by any means (graphically, electronically, or mechanically, including photocopying, recording, or
If these
have been
accomplished,
what
remains
of pregnancy
with history
taping)pelvis.
without
the expressed
written
permission
from
AAPCisand theSupervision
sources contained
within.
for
the
fetal
head
to
pass
below
the
pubic
arch
and
of ectopicwithout
or molarthe
pregnancy,
O09.12
This manual may not be copied, reproduced, dismantled, out
quoted, or presented
expressedsecond
written approval
of the AAPC
introitus.
This isNo
when
mother
assists coveredtrimester
and thethrough
sourcesthe
contained
within.
partthe
of this
publication
by the copyright herein may be reproduced, stored in a retrieval
down
or pushing.
The
fetal
head(graphically,
is seen to electronically, or mechanically, including photocopying, recording, or
systemby
or bearing
transmitted
in any
form or by
any
means
theexpressed
labia part.written
At thispermission
point, the woman
may and theSupervision
of pregnancy
with history of
taping)crown
withoutasthe
from AAPC
sources contained
within.
O09.13
feel
a
burning
or
stinging
sensation.
ectopic orwithout
molar pregnancy,
third
trimester
This manual may not be copied, reproduced, dismantled, quoted, or presented
the expressed
written
approval of the AAPC
and theBirth
sources
contained
within.
Nothe
part
of this publication
of the
fetal head
signals
successful
completioncovered by the copyright herein may be reproduced, stored in a retrieval
systemof
orthe
transmitted
in any form
or by any
means
or mechanically,
photocopying,
As demonstrated
in the codesincluding
above, sometimes
the recording, or
fourth mechanism
of labor
(delivery
by(graphically,
extension), electronically,
taping)and
without
the
expressed
written
permission
from
AAPC
and
the
sources
contained
within.
trimester
is
built
into
the
code.
According
to
the
guideis followed by the fifth and sixth mechanisms (restiThis manual
may
not
be
copied,
reproduced,
dismantled,
quoted,
or
presented
without
the
expressed
written
approval
of the AAPC
lines,
assignment
of
final
character
for
trimester
should
tution and external rotation). The second stage of labor
and thewill
sources
contained
within.
No
part
of
this
publication
covered
by
the
copyright
herein
may
be
reproduced,
stored
be based on the trimester for the current admission/ in a retrieval
vary to some extent, depending on how successfully
systemthe
or transmitted
in any
form
or accomplished.
by any means (graphically, electronically,
or mechanically,
photocopying,
encounter. This
applies to theincluding
assignment
of trimester recording, or
preceding tasks
have
been
taping) without the expressed written permission from AAPC and the
contained
within.
forsources
pre-existing
conditions
as well as those that develop
This manual
not be copied,
reproduced,
dismantled, quoted, or during
presented
without
written
approval
of the AAPC
or are
due tothe
theexpressed
pregnancy.
Whenever
delivery
Thirdmay
Stage:
Umbilical
Cord
and the sources contained within. No part of this publication covered
by
the
copyright
herein
may
be
reproduced,
stored
occurs during the current admission, and there is an in
ina retrieval
Closure
and
Placental
Expulsion
system or transmitted in any form or by any means (graphically, electronically,
mechanically,
including
photocopying,
childbirth or
option
for the obstetric
complication
beingrecording, or
thirdthe
stage
of labor written
is the period
from just
after
the and the
taping)The
without
expressed
permission
from
AAPC
sources
within.
coded,
the contained
in childbirth
code should be assigned.
fetus ismay
expelled
just reproduced,
after the placenta
is expelled.
This manual
not beuntil
copied,
dismantled,
quoted, or presented without the expressed written approval of the AAPC
The
umbilical
cord
is
routinely
clamped
and
cut in thiscovered by the copyright herein may be reproduced, stored in a retrieval
and the sources contained within. No part of this publication
but it would
normally
close
naturally
if not electronically, or mechanically, including photocopying, recording, or
systemstage,
or transmitted
in any
form or
by any
meanseven
(graphically,
taping) without the expressed written permission from AAPC and the sources contained within.
2012 AAPC. All rights reserved.
011912

www.aapc.com

Pregnancy

Module 13

This manual may not be copied, reproduced, dismantled, quoted, or presented without the expressed written approval of the AAPC
and the sources contained within. No part of this publication covered by the copyright herein may be reproduced, stored in a retrieval
system or transmitted in any form or by any means (graphically, electronically, or mechanically, including photocopying, recording, or
taping) without the expressed written permission from AAPC and the sources
within.
is seen contained
for a suspected
chromosomal abnormality in the
for (suspected)
central
nervous quoted, or presented
This manualMaternal
may not care
be copied,
reproduced,
dismantled,
without
thecoded
expressed
written approval of the AAPC
fetus,
it
would
be
to O35.1xx1.
O35.0
system
malformation
and the sources
contained
within.in
Nofetus
part of this publication covered by the copyright herein may be reproduced, stored in a retrieval
system or transmitted in any form or by any means (graphically, electronically, or mechanically, including photocopying, recording, or
Singlecontained
live birth within.
Z37.0
Maternal
care for (suspected)
chromosomal
taping) without
the expressed
written permission
from AAPC and the sources
O35.1
in fetus reproduced, dismantled, quoted, or presented without the expressed written approval of the AAPC
This manualabnormality
may not be copied,
Single
stillbirth
and the sources contained within. No part of this publication covered by the
copyright
herein may be reproduced, stored Z37.1
in a retrieval
Maternal care
forform
(suspected)
hereditary
system or transmitted
in any
or by any
means (graphically, electronically, or mechanically, including photocopying, recording, or
O35.2
Twins,contained
both liveborn
Z37.2
disease
fetus written permission from AAPC and the sources
taping) without
the in
expressed
within.
This manual may not be copied, reproduced, dismantled, quoted, or presented without the expressed written approval of the AAPC
Twins,
one liveborn
stillborn stored Z37.3
Maternal
care for
(suspected)
to fetus
and the sources
contained
within.
No partdamage
of this publication
covered by the
copyright
hereinand
mayone
be reproduced,
in a retrieval
O35.3
from viral in
disease
in mother
system or transmitted
any form
or by any means (graphically, electronically,
or
mechanically,
including
photocopying,
recording, or
Twins, both stillborn
Z37.4
taping) without the expressed written permission from AAPC and the sources contained within.
for (suspected)
damage
to fetusquoted, or presented
This manualMaternal
may not care
be copied,
reproduced,
dismantled,
without
theguidelines,
expressed awritten
approval
of the AAPC
According
to the
code from
category
O35.4
fromcontained
alcohol within. No part of this publication covered byZ37,
and the sources
the Outcome
copyright of
herein
may
be
reproduced,
stored
in a retrieval
delivery, should be included on every
system or transmitted in any form or by any means (graphically, electronically,
or
mechanically,
including
photocopying,
recording, or
maternal record when a delivery has occurred. These
taping) without the expressed written permission from AAPC and the sources
contained
within.
codes are not to be used on subsequent records or on the
Inmay
the codes
thereproduced,
7th character
extender isquoted, or presented
This manual
not beabove,
copied,
dismantled,
without
the expressed written approval of the AAPC
newborn
record.
necessary.
It is shown
thepart
nextoftable.
and the sources
contained
within.inNo
this publication covered by the copyright herein may be reproduced, stored in a retrieval
system or transmitted in any form or by any means (graphically, electronically,
or mechanically,
includingisphotocopying,
or
Where applicable,
a 7th character
to be assignedrecording,
for
taping) without
the
expressed
written
permission
from
AAPC
and
the
sources
contained
within.
certain
categories
to
identify
the
fetus
for
which
the
One of the following 7th characters is to be assigned to
This manualeach
maycode
not be
copied,
reproduced,
dismantled,
withoutcode
the expressed
complication
applies. written approval of the AAPC
under
category
O35. 7th
character 0quoted,
is usedor presented
and the sources
contained
within.
Nomultiple
part of this
publication
for single
gestations
and
gestations
wherecovered by the copyright herein may be reproduced, stored in a retrieval
Assign 7th
character 0:including photocopying, recording, or
system or transmitted
any form or7th
bycharacters
any means1(graphically,
or mechanically,
the fetus isin
unspecified.
through 9 electronically,
taping) without
thecases
expressed
written
permission
from AAPC
contained within.
are for
of multiple
gestations
to identify
the and the sources
For single gestations
This manualfetus
mayfor
notwhich
be copied,
reproduced,
dismantled,
quoted,
the code
applies. The
appropriate
codeor presented without the expressed written approval of the AAPC
When
the documentation
in the recordstored
is in a retrieval
and the sources
within.
No part
of this publication
by the
copyright
herein may be reproduced,
fromcontained
category O30,
Multiple
gestations,
must alsocovered
be
insufficient
to
determine
the
fetus
affected
andrecording,
it is
system or transmitted
in any
form orabycode
anyfrom
means
(graphically,
or
assigned when
assigning
category
O35 electronically, or mechanically, including photocopying,
not
possible
to
obtain
clarification
taping) without
the
expressed
written
permission
from
AAPC
and
the
sources
contained
within.
that has a 7th character of 1 through 9.
When
it is the
not expressed
possible towritten
clinically
determine
This manual may not be copied, reproduced, dismantled, quoted, or presented
without
approval
of the AAPC
which
fetus
is
affected
and the sources
within. or
Nounspecified
part of this publication covered by the copyright herein may be reproduced, stored in a retrieval
0 contained
not applicable
system or transmitted in any form or by any means (graphically, electronically, or mechanically, including photocopying, recording, or
Other important guidelines for chapter 15 state that
taping) without
expressed
written permission from AAPC and the sources contained within.
1 the fetus
1
codes from this chapter have sequencing priority over
This manual may not be copied, reproduced, dismantled, quoted, or presented without the expressed written approval of the AAPC
codes from other chapters. Additional codes from other
and the sources
2 contained
fetus 2 within. No part of this publication covered by the copyright herein may be reproduced, stored in a retrieval
chapters may be used in conjunction with chapter 15
system or transmitted in any form or by any means (graphically, electronically, or mechanically, including photocopying, recording, or
codes to further specify conditions. Should the provider
taping) without
expressed
written permission from AAPC and the sources contained within.
3 the fetus
3
document that the pregnancy is incidental to the
This manual may not be copied, reproduced, dismantled, quoted, or presented without the expressed written approval of the AAPC
encounter, then code Z33.1 Pregnant state, incidental,
and the sources
4 contained
fetus 4 within. No part of this publication covered by the copyright herein may be reproduced, stored in a retrieval
should be used in place of any chapter 15 codes. It is the
system or transmitted in any form or by any means (graphically, electronically, or mechanically, including photocopying, recording, or
providers responsibility to state that the condition being
taping) without
expressed
written permission from AAPC and the sources contained within.
5 the fetus
5
treated is not affecting the pregnancy.
This manual may not be copied, reproduced, dismantled, quoted, or presented without the expressed written approval of the AAPC
and the sources
within. No part of this publication covered byInthe
copyright
herein
may beisreproduced,
in a for
retrieval
9 contained
other fetus
instances
where
a patient
admitted tostored
a hospital
system or transmitted in any form or by any means (graphically, electronically,
or
mechanically,
including
photocopying,
recording,
or
complications of pregnancy during one trimester and
th
taping) without
the
expressed
written
permission
from
AAPC
and
the
sources
contained
within.
Since the 7 character extender is required on the codes,
remains in the hospital into a subsequent trimester, the
This manual
not beplaceholders
copied, reproduced,
dismantled,
quoted,
without
the expressed
written approval
of the AAPC
themay
dummy
must be used
along with
the or presented
trimester
character
for the antepartum
complication
and the sources
within.
part with
of thisa single
publication
covered bycode
the copyright
herein
may
be
reproduced,
stored
a retrieval
codes.contained
For example,
if a No
woman
gestation
should be assigned to the trimester in whichinthe
system or transmitted in any form or by any means (graphically, electronically,
or
mechanically,
including
photocopying,
recording,
or
complications developed.
taping) without the expressed written permission from AAPC and the sources contained within.

Anatomy and Pathophysiology for ICD-10

2012 AAPC. All rights reserved.


011912

Module 13

Pregnancy

This manual may not be copied, reproduced, dismantled, quoted, or presented without the expressed written approval of the AAPC
and the sources contained within. No part of this publication covered by the copyright herein may be reproduced, stored in a retrieval
system or transmitted in any form or by any means (graphically, electronically, or mechanically, including photocopying, recording, or
taping)For
without
theprenatal
expressed
written
AAPC
contained
within.
routine
visits
in thepermission
outpatientfrom
setting
whenand the
To sources
code abortions
in ICD-10-CM
you need to know:
This manual
maynonot
be copied, reproduced,
dismantled,
quoted, or presented without the expressed written approval of the AAPC
there are
complications,
a code from
category Z34,
and theEncounter
sources contained
within.ofNo
part ofpregnancy,
this publication
the copyright herein may be reproduced, stored in a retrieval
for supervision
normal
shouldcovered bytype
systembe
or used
transmitted
in any form
or by any
means
(graphically,
or mechanically, including photocopying, recording, or
complications
as the first-listed
diagnosis.
These
codes
should electronically,
taping)not
without
theinexpressed
written
contained
within.
be used
conjunction
withpermission
chapter 15 from
codes.AAPC and the sources
complete vs incomplete
This manual may not be copied, reproduced, dismantled, quoted, or presented without the expressed written approval of the AAPC
of gestation
many cases
in thiswithin.
chapter,
codes
are also covered bystage
and theInsources
contained
Nomultiple
part of this
publication
the copyright herein may be reproduced, stored in a retrieval
to code
complete
For example,
systemnecessary
or transmitted
in aany
form ordiagnosis.
by any means
(graphically, electronically, or mechanically, including photocopying, recording, or
abortion
O02.1
a
woman
in
her
second
trimester
with
a
group
strep and theMissed
taping) without the expressed written permission
fromA AAPC
sources contained within.
kidneymay
infection
coded with dismantled,
O23.01 Infec-quoted, or presented without the expressed written approval of the AAPC
This manual
not bewould
copied,bereproduced,
or excessive hemorrhage following O03.1
of kidney
in pregnancy,
second
and B95.0coveredDelayed
and thetions
sources
contained
within. No
part trimester
of this publication
by the copyright herein may be reproduced, stored in a retrieval
incomplete
abortion
as theorcause
ofmeans
disease(graphically,
classified electronically, orspontaneous
systemStreptococcus,
or transmittedgroup
in anyA,form
by any
mechanically, including photocopying, recording, or
taping)elsewhere.
without the expressed written permission from AAPC and the sources contained within.
Unspecified complication following
O03.30
This manual may not be copied, reproduced, dismantled, quoted, or presented without the expressed written approval of the AAPC
incomplete spontaneous abortion
and the sources contained within. No part of this publication covered by the copyright herein may be reproduced, stored in a retrieval
system or transmitted in any form or by any means (graphically, electronically, or mechanically, including photocopying, recording, or
Incomplete spontaneous abortion without O03.4
taping)Ectopic
without thePregnancy
expressed written permission from AAPC and the sources contained within.
complication
This manual
may not
be copied,
reproduced,
dismantled,
quoted, or presented without the expressed written approval of the AAPC
An ectopic
pregnancy
occurs
when there
is an abnormal
and theimplantation
sources contained
within. ovum
No part
of thisofpublication
of a fertilized
outside
the uterinecovered by the copyright herein may be reproduced, stored in a retrieval
Delayed or excessive hemorrhage following O03.6
systemcavity,
or transmitted
in referred
any formtoorasbya tubal
any means
(graphically, electronically, or mechanically, including photocopying, recording, or
most often
pregnancy.
complete or unspecified abortion
taping)Approximately
without the expressed
written
permission
from
AAPC and the sources contained within.
90% of all
ectopic
pregnancies
occur
This manual
not be
copied,
reproduced,
or presented without the expressed written approval of the AAPC
in the may
fallopian
tubes.
To code
ectopic dismantled,
pregnancies quoted,
in
Unspecified complication following
O03.80
and theICD-10-CM
sources contained
within.
No part of this publication covered by the copyright herein may be reproduced, stored in a retrieval
you need
to know:
complete or unspecified spontaneous
system or transmitted in any form or by any means (graphically, electronically, or mechanically, including photocopying, recording, or
abortion
location
pregnancy
taping) without
the of
expressed
written permission from AAPC and the sources contained within.
This manual may not be copied, reproduced, dismantled, quoted, or presented without the expressed written approval of the AAPC
Delayed or excessive hemorrhage following O04.6
and the Abdominal
sources contained
within. No part of this publication
by the copyright herein may be reproduced, stored in a retrieval
pregnancy
O00.0coveredinduced
termination of pregnancy
system or transmitted in any form or by any means (graphically, electronically, or mechanically, including photocopying, recording, or
taping) without
the expressed written permission from AAPC
sources contained within.
Tubal pregnancy
O00.1 and theGenital
tract and pelvic infection
O07.0
This manual may not be copied, reproduced, dismantled, quoted, or presented without the expressed written approval of the AAPC
following failed attempted termination of
and the Ovarian
sources contained
by the copyright herein may be reproduced, stored in a retrieval
pregnancywithin. No part of this publication
O00.2coveredpregnancy
system or transmitted in any form or by any means (graphically, electronically, or mechanically, including photocopying, recording, or
taping) without
the expressed
written permission from AAPC
Other ectopic
pregnancy
O00.8 and the sources contained within.
This manual may not be copied, reproduced, dismantled, quoted, or presented without the expressed written approval of the AAPC
Gestational
and the Ectopic
sources pregnancy
contained within.
No part of this publication
by the copyrightDiabetes
herein may be reproduced, stored in a retrieval
unspecified
O00.9covered
This
disorder
develops
during
the latterphotocopying,
part of preg- recording, or
system or transmitted in any form or by any means (graphically, electronically, or mechanically,
including
nancy
and
the
symptoms
usually
disappear
at the end
taping) without the expressed written permission from AAPC and the sources contained within.
of
pregnancy.
Women
who
have
gestational
diabetes
This manual
may not be copied, reproduced, dismantled, quoted, or presented without the expressed written approval
of the AAPC
Abortion
have
a
higher
possibility
of
developing
it
with
subseand theAn
sources
contained
within.
No
part
of
this
publication
covered
by
the
copyright
herein
may
be
reproduced,
stored
in a retrieval
abortion is the term used to describe a termination of
quent
pregnancies.
Gestational
diabetes
is
an
inability
to
systempregnancy
or transmitted
inthe
anyfetus
formhas
or reached
by any means
(graphically,
or mechanically, including photocopying, recording,
or
before
a viable
age. The electronically,
metabolize
carbohydrates,
with
resultant
hyperglycemia.
taping)term
without
the
expressed
written
permission
from
AAPC
and
the
sources
contained
within.
abortion is a medical term used to denote any type
thatwithout
increase
risk of developing
gestational
This manual
may not of
be pregnancy.
copied, reproduced,
quoted, or Factors
presented
thethe
expressed
written approval
of the AAPC
of termination
Many usedismantled,
the term miscardiabetes
include:
and theriage
sources
contained
within.
No
part
of
this
publication
covered
by
the
copyright
herein
may
be
reproduced,
stored
in a retrieval
to describe a spontaneous abortion. A spontaneous
systemabortion
or transmitted
in any
formon
orits
by own
any means
(graphically, electronically,
is one that
occurs
due to abnor obesityor mechanically, including photocopying, recording, or
taping)malities
withoutofthe
expressed
written
permission
from
AAPC
and
the
sources contained within.
the embryo or fetus. Symptoms can include
maternal
age over
years written approval of the AAPC
This manual
may
not
be
copied,
reproduced,
dismantled,
quoted,
or
presented
without
the 30
expressed
vaginal bleeding, rhythmic uterine cramping, continual
history of birthing large babies
and thebackache,
sources contained
within.
No partinofthe
this
publication
and a feeling
of pressure
pelvic
area. covered by the copyright herein may be reproduced, stored in a retrieval
system or transmitted in any form or by any means (graphically, electronically,
or mechanically,
family history
of diabetesincluding photocopying, recording, or
taping) without the expressed written permission from AAPC and the sources contained within.

Diseases and Disorders in Pregnancy

2012 AAPC. All rights reserved.


011912

www.aapc.com

Pregnancy

Module 13

This manual may not be copied, reproduced, dismantled, quoted, or presented without the expressed written approval of the AAPC
and the sources contained within. No part of this publication covered by the copyright herein may be reproduced, stored in a retrieval
system or transmitted in any form or by any means (graphically, electronically, or mechanically, including photocopying, recording, or
taping) without
the expressed
written stillborn
permission
from AAPC and the sources contained within.
previous,
unexplained
birth
Pre-existing
hypertension
This manual may not be copied, reproduced, dismantled, quoted, or presented
withoutessential
the expressed
written approval O10.013
of the AAPC
previous birth with congenital defects
complicating
trimester stored in a retrieval
and the sources contained within. No part of this publication covered by the
copyright pregnancy,
herein maythird
be reproduced,
system or transmitted
in any
form or bydiabetes
any means
(graphically,
electronically, or mechanically, including photocopying, recording, or
In order to code
gestational
in ICD-10-CM
you
Pre-existing
hypertensive
O10.113
taping) without
the
expressed
written
permission
from
AAPC
and
the sources
contained
within. heart disease
need to know the following:
complicating
third
trimester
This manual may not be copied, reproduced, dismantled, quoted, or presented
without pregnancy,
the expressed
written
approval of the AAPC
trimester
and the sources
contained within. No part of this publication covered by the copyright herein may be reproduced, stored in a retrieval
Pre-existing
hypertensive
chronicphotocopying,
kidney O10.213
system or transmitted
in any
form or by any means (graphically, electronically,
or mechanically,
including
recording, or
associated
complications
disease
complicating
pregnancy,
third
taping) without
the
expressed
written
permission
from
AAPC
and
the
sources
contained
within.
type
trimester
This manual may not be copied, reproduced, dismantled, quoted, or presented
without the expressed written approval of the AAPC
and the sources contained within. No part of this publication covered by the copyright herein may be reproduced, stored in a retrieval
Pre-existing
type
2, in(graphically,
O24.112electronically,
Pre-existing
hypertensive
heart and
O10.313
system or transmitted
in diabetes
any formmellitus,
or by any
means
or mechanically,
including
photocopying,
recording, or
pregnancy,
second
trimester
chronic
kidney disease
taping) without the expressed written permission from AAPC and the sources
contained
within.complicating pregnancy,without
third trimester
This manual may not be copied, reproduced, dismantled, quoted, or presented
the expressed written approval of the AAPC
Unspecified
pre-existing
mellitus
O24.312
and the sources
contained
within. Nodiabetes
part of this
publication
covered by the copyright herein may be reproduced, stored in a retrieval
in pregnancy,
second
Pre-existing
hypertension
with preO11.3
system or transmitted
in any
formtrimester
or by any means (graphically, electronically,
or mechanically,
including
photocopying,
recording, or
eclampsia,
third within.
trimester
taping) without the expressed written permission from AAPC and the sources
contained
mellitus in childbirth
This manualGestational
may not bediabetes
copied, reproduced,
dismantled, O24.420
quoted, or presented without the expressed written approval of the AAPC
diet contained
controlled within. No part of this publication covered by the
Gestational
edema,
O12.03
and the sources
copyright
hereinthird
may trimester
be reproduced, stored
in a retrieval
system or transmitted in any form or by any means (graphically, electronically, or mechanically, including photocopying, recording, or
Other
diabetespermission
mellitus infrom AAPC
O24.812
Gestational
proteinuria,
O12.13
taping) without
thepre-existing
expressed written
and the sources
contained
within. third trimester
pregnancy,
second
trimester
This manual may not be copied, reproduced, dismantled, quoted, or presented without the expressed written approval of the AAPC
Gestational
edema
thirdstored
O12.23
and the sources contained within. No part of this publication covered by the
copyright
hereinwith
mayproteinuria,
be reproduced,
in a retrieval
Unspecifiedindiabetes
in pregO24.912electronically,
trimester
system or transmitted
any formmellitus
or by any
means (graphically,
or mechanically, including photocopying, recording, or
nancy,
trimester
taping) without
thesecond
expressed
written permission from AAPC and the sources contained within.
Gestational
hyperThis manual may not be copied, reproduced, dismantled, quoted, or presented
without[pregnancy-induced]
the expressed written
approval O13.3
of the AAPC
tension
without
significant
and the sources
contained
No part
ofZ79.4,
this publication
copyright
herein
may beproteinuria,
reproduced, stored in a retrieval
According
to thewithin.
guidelines,
code
Long-termcovered by the
third trimester
system or transmitted
form or
by any
(graphically,
or mechanically, including photocopying, recording, or
(current) useinofany
insulin,
should
notmeans
be assigned
with electronically,
taping) without
the
expressed
written
permission
from
AAPC
and
the
sources
contained
within.
codes from subcategory O24.4.
Mild to
moderate
pre-eclampsia,
third
This manual may not be copied, reproduced, dismantled, quoted, or presented
without
the expressed
written
approval O14.03
of the AAPC
trimester
and the sources
contained within.
part of this publication covered by the
copyright herein may be reproduced, stored in a retrieval
Hypertension
inNo
Pregnancy
system or transmitted
any form orisbythe
any
means (graphically,
Gestational in
hypertension
development
of hyper-electronically, or mechanically, including photocopying, recording, or
Severecontained
pre-eclampsia,
third trimester
O14.13
taping) without
the
expressed
written
permission
from
AAPC
within.
tension during pregnancy, after 20 weeks gestation. and the sources
This manual
may
not be copied,
reproduced,
quoted, or presented without the expressed written approval of the AAPC
The
hypertension
resolves
typicallydismantled,
after the pregnancy
and the sources
contained
within.
No
part
of
this
publication
by the copyright herein may be reproduced, stored in a retrieval
ends. Hypertension during pregnancy can also leadcovered
to
Codes from
Chapter 15 (O00-O99A)
require the use
of
system or transmitted
in
any
form
or
by
any
means
(graphically,
electronically,
or mechanically,
including photocopying,
recording,
or
preeclampsia which is hypertension with proteinuria or
an
additional
code
from
category
Z3A.
Weeks
of
gestataping) without
the
expressed
written
permission
from
AAPC
and
the
sources
contained
within.
edema or to the most severe form of hypertension which
tion, towithout
identifythe
theexpressed
specific week
of the
pregnancy.
This manual
may not be copied, reproduced, dismantled, quoted, or presented
written
approval
of the AAPC
is eclampsia.
These
codes
are
for
use,
only
on
the
maternal
record,
and the sources contained within. No part of this publication covered by the copyright herein may be reproduced, stored
in a to
retrieval
indicate
the
weeks
of
gestation
of
the
pregnancy.
In order to code
hypertension
in pregnancy
documentasystem or transmitted
in any
form or by any
means (graphically,
electronically, or mechanically, including photocopying, recording, or
tion must
include: written permission from AAPC and the sources contained within.
taping) without
the expressed
Code first complications of pregnancy, childbirth, and
This manual may not be copied, reproduced, dismantled, quoted, or presented without the expressed written approval of the AAPC
the puerperium (O00-O9A).
ifcontained
hypertension
wasNo
pre-existing
and the sources
within.
part of this publication covered by the copyright herein may be reproduced, stored in a retrieval
trimester
system or transmitted
in any form or by any means (graphically, electronically, or mechanically, including photocopying, recording, or
Weekscontained
of gestation
of pregnancy not
Z3A.00
taping) without
the
expressed
within.
complications written permission from AAPC and the sources
specified
This manual may not be copied, reproduced, dismantled, quoted, or presented without the expressed written approval of the AAPC
and the sources contained within. No part of this publication covered by the copyright herein may be reproduced, stored in a retrieval
system or transmitted in any form or by any means (graphically, electronically, or mechanically, including photocopying, recording, or
taping) without the expressed written permission from AAPC and the sources contained within.

Anatomy and Pathophysiology for ICD-10

2012 AAPC. All rights reserved.


011912

Module 13

Pregnancy

This manual may not be copied, reproduced, dismantled, quoted, or presented without the expressed written approval of the AAPC
and the sources contained within. No part of this publication covered by the copyright herein may be reproduced, stored in a retrieval
system or transmitted in any form or by any means (graphically, electronically, or mechanically, including photocopying, recording, or
taping) without the expressed written permission from AAPC and the sources contained within.
Less than
8 weeks
gestation
of pregnancy
Z3A.01
30 weeks without
gestationthe
of expressed
pregnancywritten approval
Z3A.30
This manual
may not
be copied,
reproduced,
dismantled,
quoted, or presented
of the AAPC
and the sources contained within. No part of this publication covered by the copyright herein may be reproduced, stored in a retrieval
8 weeks
gestation
of pregnancy
Z3A.08
31 weeks gestation
of pregnancy
Z3A.31 recording, or
system or
transmitted
in any
form or by any means (graphically,
electronically,
or mechanically,
including photocopying,
taping) without the expressed written permission from AAPC and the sources contained within.
9 weeks
of pregnancy
Z3A.09
32 weeks gestation
of pregnancy
Z3A.32
This manual
maygestation
not be copied,
reproduced, dismantled,
quoted, or presented
without the
expressed written approval
of the AAPC
and the sources contained within. No part of this publication covered by the copyright herein may be reproduced, stored in a retrieval
10transmitted
weeks gestation
of form
pregnancy
Z3A.10
33 weeks gestation
of pregnancy
Z3A.33 recording, or
system or
in any
or by any means (graphically,
electronically,
or mechanically,
including photocopying,
taping) without the expressed written permission from AAPC and the sources contained within.
11 weeks
of pregnancy
Z3A.11
34 weeks without
gestationthe
of expressed
pregnancywritten approval
Z3A.34
This manual
maygestation
not be copied,
reproduced, dismantled,
quoted, or presented
of the AAPC
and the sources contained within. No part of this publication covered by the copyright herein may be reproduced, stored in a retrieval
12transmitted
weeks gestation
of form
pregnancy
Z3A.12
35 weeks gestation
of pregnancy
Z3A.35 recording, or
system or
in any
or by any means (graphically,
electronically,
or mechanically,
including photocopying,
taping) without the expressed written permission from AAPC and the sources contained within.
13 weeks
of pregnancy
Z3A.13
36 weeks without
gestationthe
of expressed
pregnancywritten approval
Z3A.36
This manual
may gestation
not be copied,
reproduced, dismantled,
quoted, or presented
of the AAPC
and the sources contained within. No part of this publication covered by the copyright herein may be reproduced, stored in a retrieval
14transmitted
weeks gestation
of form
pregnancy
Z3A.14
37 weeks gestation
of pregnancy
Z3A.37 recording, or
system or
in any
or by any means (graphically,
electronically,
or mechanically,
including photocopying,
taping) without the expressed written permission from AAPC and the sources contained within.
15 weeks
of pregnancy
Z3A.15
38 weeks without
gestationthe
of expressed
pregnancywritten approval
Z3A.38
This manual
may gestation
not be copied,
reproduced, dismantled,
quoted, or presented
of the AAPC
and the sources contained within. No part of this publication covered by the copyright herein may be reproduced, stored in a retrieval
16transmitted
weeks gestation
of form
pregnancy
Z3A.16
39 weeks gestation
of pregnancy
Z3A.39 recording, or
system or
in any
or by any means (graphically,
electronically,
or mechanically,
including photocopying,
taping) without the expressed written permission from AAPC and the sources contained within.
17 weeks
of pregnancy
Z3A.17
40 weeks without
gestationthe
of expressed
pregnancywritten approval
Z3A.40
This manual
maygestation
not be copied,
reproduced, dismantled,
quoted, or presented
of the AAPC
and the sources contained within. No part of this publication covered by the copyright herein may be reproduced, stored in a retrieval
18transmitted
weeks gestation
of form
pregnancy
Z3A.18
41 weeks gestation
of pregnancy
Z3A.41 recording, or
system or
in any
or by any means (graphically,
electronically,
or mechanically,
including photocopying,
taping) without the expressed written permission from AAPC and the sources contained within.
19 weeks
of pregnancy
Z3A.19
42 weeks without
gestationthe
of expressed
pregnancywritten approval
Z3A.42
This manual
may gestation
not be copied,
reproduced, dismantled,
quoted, or presented
of the AAPC
and the sources contained within. No part of this publication covered by the copyright herein may be reproduced, stored in a retrieval
20transmitted
weeks gestation
of form
pregnancy
Z3A.20
Greater than
42weeks gestation
of photocopying,
Z3A.49 recording, or
system or
in any
or by any means (graphically,
electronically,
or mechanically,
including
pregnancy
taping) without the expressed written permission from AAPC and the sources contained within.
21 weeks
of pregnancy
Z3A.21
This manual
may gestation
not be copied,
reproduced, dismantled,
quoted, or presented without the expressed written approval of the AAPC
and the sources contained within. No part of this publication covered
by the copyright herein may be reproduced, stored in a retrieval
Sources
22
weeks
gestation
of
pregnancy
Z3A.22
system or transmitted in any form or by any means (graphically, electronically, or mechanically, including photocopying, recording, or
Comprehensive
Medical
Terminology (Fourth Edition) by
taping) without the expressed written permission from AAPC and the
sources contained
within.
Betty
Davis
Jones.
23 weeks
of pregnancy
Z3A.23
This manual
may gestation
not be copied,
reproduced, dismantled,
quoted, or presented without the expressed written approval of the AAPC
and the sources contained within. No part of this publication covered by the copyright herein may be reproduced, stored in a retrieval
Stedmans Medical Dictionary, 28th edition
24transmitted
weeks gestation
of form
pregnancy
Z3A.24
system or
in any
or by any means (graphically,
electronically, or mechanically, including photocopying, recording, or
taping) without the expressed written permission from AAPC and the
sources
contained
Bates
Pocket
Guide towithin.
Physical Examination and History
25 weeks
of pregnancy
Z3A.25
This manual
may gestation
not be copied,
reproduced, dismantled,
quoted, or Taking,
presented
without
the
expressed
written approval of the AAPC
Third Edition (Lynn
S. Bickley-Lippincott)
and the sources contained within. No part of this publication covered by the copyright herein may be reproduced, stored in a retrieval
26transmitted
weeks gestation
of form
pregnancy
Z3A.26
system or
in any
or by any means (graphically,
electronically, or mechanically, including photocopying, recording, or
taping) without the expressed written permission from AAPC and the sources contained within.
27 weeks
of pregnancy
Z3A.27
This manual
may gestation
not be copied,
reproduced, dismantled,
quoted, or presented without the expressed written approval of the AAPC
and the sources contained within. No part of this publication covered by the copyright herein may be reproduced, stored in a retrieval
28transmitted
weeks gestation
of form
pregnancy
Z3A.28
system or
in any
or by any means (graphically,
electronically, or mechanically, including photocopying, recording, or
taping) without the expressed written permission from AAPC and the sources contained within.
29 weeks
of pregnancy
Z3A.29
This manual
may gestation
not be copied,
reproduced, dismantled,
quoted, or presented without the expressed written approval of the AAPC
and the sources contained within. No part of this publication covered by the copyright herein may be reproduced, stored in a retrieval
system or transmitted in any form or by any means (graphically, electronically, or mechanically, including photocopying, recording, or
taping) without the expressed written permission from AAPC and the sources contained within.
2012 AAPC. All rights reserved.
011912

www.aapc.com