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Basic ICD-10-CM/PCS Coding 2013 Edition

Chapter 18: Pregnancy, Childbirth, and the Puerperium (O00O9A)

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Learning Objectives
Review the chapters learning objectives and key terms Concepts 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/PCS Coding of obstetrical conditions requires special attention to definitions and details At the conclusion of this chapter, what must you know about pregnancy, childbirth and the puerperium to code these conditions and the related therapeutic procedures?

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Chapter 15 of ICD-10-CM, Pregnancy, Childbirth and the Puerperium (O00O9A) First character of code is letter O, not zero These codes used on mothers record, not infants record

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Chapter 15 of ICD-10-CM, Pregnancy, Childbirth and the Puerperium (O00O9A) The blocks of codes in Chapter 15 are
o O00O08 o O09 o O10O16 o O20O29 Pregnancy with abortive outcome Supervision of high risk pregnancy Edema, proteinuria and hypertensive disorders in pregnancy, childbirth and puerperium Other maternal disorders predominantly related to pregnancy Maternal care related to the fetus and amniotic cavity and possible delivery problems

o O30O48

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Chapter 15 of ICD-10-CM, Pregnancy, Childbirth and the Puerperium (O00O9A) The blocks of codes in Chapter 15 are
o O60O77 o O80, O82 o O85O92 o O94O9A Complications of labor and delivery Encounter for delivery Complications predominantly related to the puerperium Other obstetric conditions, not elsewhere classified

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Chapter 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

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Chapter 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 is
o Encounter (for), termination of pregnancy, elective

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Chapter 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

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Chapter 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 identified o Example: 0 not applicable or unspecified 1 fetus 1 2 fetus 2 3 fetus 3 4 fetus 4 5 fetus 5 9 other fetus

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

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Coding Instructional Notes for ICD-10-CM Chapter 15 Trimesters are counted from the first day of the last menstrual period and defined as
o 1st trimester: less than 14 weeks 0 days o 2nd trimester: 14 weeks 0 days to less than 28 weeks 0 days o 3rd trimester: 28 weeks 0 days until delivery

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Coding 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

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Coding Guidelines for ICD-10-CM Chapter 15 NCHS has published chapter-specific guidelines for ICD-10-CM
o General rules for obstetric cases o Selection of OB principal or first-listed diagnosis o Pre-existing conditions versus conditions due to the pregnancy o Pre-existing hypertension in pregnancy o Fetal conditions affecting the management of the mother
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Coding Guidelines for ICD-10-CM Chapter 15 NCHS has published chapter-specific guidelines for ICD-10-CM (continued)
o HIV infection in pregnancy, childbirth and the puerperium o Diabetes mellitus in pregnancy o Long term use of insulin o Gestational (pregnancy induced) diabetes o Sepsis and septic shock complicating abortion, pregnancy, childbirth and the puerperium
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Coding Guidelines for ICD-10-CM Chapter 15 NCHS has published chapter-specific guidelines for ICD-10-CM (continued)
o Puerperal sepsis o Alcohol and tobacco use during pregnancy, childbirth and the puerperium o Poisoning, toxic effects, adverse effects and underdosing in a pregnant patient o Normal delivery, Code O80

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Coding Guidelines for ICD-10-CM Chapter 15 NCHS has published chapter-specific guidelines for ICD-10-CM (continued)
o The peripartum and postpartum periods o Sequelae of complication of pregnancy, childbirth and the puerperium o Abortions o Abuse in a pregnant patient

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Coding Conditions for ICD-10-CM Chapter 15


Codes begin with the letter O, not zero (0) Codes include both letters and numbers
o O00 Letter O, digit zero, digit zero

Chapter 15 codes are used only on maternal records and never on newborn infant records These are conditions related to or aggravated by the pregnancy, childbirth, or by the puerperium or maternal causes or obstetric causes

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Coding 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: o First Trimester: less than 14 weeks, 0 days o Second Trimester: 14 weeks, 0 days to less than 28 weeks, 0 days o Third Trimester: 28 weeks, 0 days until delivery

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Coding Conditions for ICD-10-CM Chapter 15


Assignment of final character for trimester is based on the trimester for the current admission or 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

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Coding Conditions for ICD-10-CM Chapter 15


Pregnancy-Related Codes in Chapter 21, Factors Influencing Health Status and Contact with Health Services o Z30 Encounter for contraceptive management o Z31 Encounter for procreative management o Z32 Encounter for pregnancy test and childbirth and childcare instruction o Z33 Pregnant state

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Coding Conditions for ICD-10-CM Chapter 15


Pregnancy-Related Codes in Chapter 21, Factors Influencing Health Status and Contact with Health Services (continued) o Z34 Encounter for supervision of normal pregnancy o Z36 Encounter for antenatal screening of mother o Z3A Weeks of Gestation
The weeks of gestation indicate the length of the pregnancy measured in completed weeks This code is used in addition to a code from Chapter 15

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Coding Conditions for ICD-10-CM Chapter 15


Pregnancy-Related Codes in Chapter 21, Factors Influencing Health Status and Contact with Health Services (continued) o Z34 Encounter for supervision of normal pregnancy o Z36 Encounter for antenatal screening of mother o Z3A Weeks of Gestation
The weeks of gestation indicate the length of the pregnancy measured in completed weeks This code is used in addition to a code from Chapter 15

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Coding Conditions for ICD-10-CM Chapter 15


Pregnancy-Related Codes in Chapter 21, Factors Influencing Health Status and Contact with Health Services (continued) o Z37 Outcome of delivery
Codes 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 stillborn

o Z39 Encounter for maternal postpartum care and examination

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Coding Conditions for ICD-10-CM Chapter 15


Pregnancy with Abortive Outcome (O00O08) o Pregnancies that end before the completion of 20 weeks of gestation o Ectopic pregnancy (O00) Fourth digit identifies the site: abdominal, tubal, ovarian, other Use additional code to identify any associated complication o Missed abortion (O02.1) Early fetal death before completion of 20 weeks of gestation with retention of dead fetus
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Coding Conditions for ICD-10-CM Chapter 15


Pregnancy with Abortive Outcome (O00O08) o 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 grams If weight cannot be determined, an estimated gestation of less than 20 completed weeks is considered an abortion Fourth characters used indicate the presence or absence of a complication Definitions of complete versus incomplete abortion

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Coding Conditions for ICD-10-CM Chapter 15


Complications Following (induced) Termination of Pregnancy (O04) o Codes used when a complication occurs after the abortion itself was completed during a previous admission o Excludes1 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 occurs o Fourth-digit code identifies the specific complication

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Coding Conditions for ICD-10-CM Chapter 15


Failed Attempted Termination of Pregnancy (O07) o Codes used when an attempted abortion fails and the pregnancy continues o The failed termination may not produce any complication o Other fourth-character subcategories are used when a complication occurs o Excludes1 note with O07 codes states that these codes are not used during an encounter for treatment of an incomplete spontaneous abortions

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Coding Conditions for ICD-10-CM Chapter 15


Complications Following Ectopic and Molar Pregnancy (O08) o Codes used when a complication occurs with an ectopic and molar pregnancy o Category O08 is used with categories O00O02 to identify any associated complication with the specific conditions included in the fourth-digit level of O08

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Coding Conditions for ICD-10-CM Chapter 15


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


Threatened Abortion (O20.0) o 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 cervix o Loss of the pregnancy is prevented and the patient remains pregnant at the end of the admission or encounter

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Coding Conditions for ICD-10-CM Chapter 15


Recurrent Pregnancy loss (O26.20O26.23, N96) o Also known as habitual or recurrent abortion o Defines the spontaneous expulsion of a dead or nonviable fetus in two or more pregnancies at any gestational age o Coding guidelines when to use codes
N96 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
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Coding Conditions for ICD-10-CM Chapter 15


Pregnancy o State of a female after conception until birth (delivery) of the child o Normal duration about 266 days o Preterm delivery: before 37 completed weeks o Term delivery: between 38 and 40 completed weeks o Postterm delivery: between 41 and 42 completed wks o Prolonged: pregnancy advanced beyond 42 completed weeks o Postpartum or puerperium begins immediately after delivery and continues for 6 weeks
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Coding Conditions for ICD-10-CM Chapter 15


Encounter for Delivery (O80O82) Category O80 is used when the pregnant female has a
o Full term single live-born infant o Spontaneous, cephalic, vaginal delivery o Delivery requiring minimal or no assistance, with or without episotomy, without fetal manipulation (that is, rotation version) or instrumentation (forceps) o Used as a single code, not used with any other code from Chapter 15 o Must be accompanied by appropriate procedure code o Additional code to indicate the outcome of delivery, Z37 category code

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Coding Conditions for ICD-10-CM Chapter 15


Encounter for Delivery (O80O82) Category O82 Encounter for Cesarean Delivery without Indication
o Pregnant female has a cesarean delivery without an indication or the reason for the cesarean delivery documented in the health records o Not the preferred diagnosis for all encounters for a cesarean delivery o Instead, code the reason for the cesarean documented in the heath record o Use Additional code from Z37 to identify the outcome of delivery

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Coding Conditions for ICD-10-CM Chapter 15


Outcome of Delivery (Z codes)
o A code from category Z37, Outcome of delivery, is used on every maternal record when a delivery occurs o Z37 is always an additional diagnosis code to identify the number and status of babies delivered o Main term in the Alphabetic Index to Diseases and Injuries is Outcome of delivery

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Coding Conditions for ICD-10-CM Chapter 15


Obstetrical and Nonobstetrical Complications
o Many preexisting conditions, including diabetes, hypertenion, and anemia, may affect or complicate the pregnancy or its management o Pregnancy may aggravate the preexisting condition o Examples of complications are
Edema, proteinuria and hypertensive disorders Maternal care related to fetus and amniotic cavity Complications of labor and delivery Complications predominantly related to the puerperium

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Preexisting Hypertenion (O10)
o Category O10, Preexisting hypertension complicating pregnancy, childbirth and the puerperium provides specific subcategories for the type of hypertensive disease
Essential hypertension Hypertensive heart disese Hypertensive chronic kidney disease Hypertensive heart and chronic kidney disease Secondary hypertension Unspecified hypertension

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Coding Conditions for ICD-10-CM Chapter 15


Other Forms of Hypertension, Pre-eclampsia and Eclampsia (O11O16)
o Includes other forms of hypertensive disease such as
Preexisting hypertension with pre-eclampsia Gestational edema and proteinuria without hypertension Gestational hypertension without significant proteinuria Pre-eclampsia Eclampsia Unspecified maternal hypertension

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Excessive Vomiting in Pregnancy (O21)
o o o o o o o Hyperemesis is excessive vomitig Hyperemesis gravidarum is severe morning sickness These codes do not require an additional code: Mild hyperemesis gravidarum Hyperemesis gravidarum with metabolic disturbance Late vomiting of pregancy Vomiting of pregnancy, unspecified

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Coding Conditions for ICD-10-CM Chapter 15


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

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Coding Conditions for ICD-10-CM Chapter 15


Preterm Labor with or without Delivery (O60)
o Onset (spontaneous) of labor before 37 completed weeks of gestation
Even 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 O60 One 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

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Coding Conditions for ICD-10-CM Chapter 15


Puerperal Sepsis (O85) and Other Puerperal Infection (O86)
o Puerperal sepsis (O85) is one of the most serious manifestations of major postpartum infection o Complication occurs during the 6 weeks or 42 days following delivery o Coder uses additional code to identify the known infectious agent (B95 B97) o Additional code is used if severe sepsis is present with or without shock o Other puerperal infection (O86) identifies localized infections that occur during the postpartum period such as
Infection of obstetric surgical wound Other infection of the genital tract Urinary tract infection, and other conditions

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Exercises
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.

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