Basic ICD10 CMPCS Coding 2013 Edition Chapter 18

Learning Objectives • Review the chapter’s 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? © 2013

Chapter 15 of ICD-10 -CM, Pregnancy, Childbirth and the Puerperium (O 00–O 9 A) • The blocks of codes in Chapter 15 are o O 00–O 08 o O 09 o O 10–O 16 o O 20–O 29 o O 30–O 48 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 © 2013

Chapter 15 of ICD-10 -CM, Pregnancy, Childbirth and the Puerperium (O 00–O 9 A) • The blocks of codes in Chapter 15 are o O 60–O 77 o O 80, O 82 o O 85–O 92 o O 94–O 9 A Complications of labor and delivery Encounter for delivery Complications predominantly related to the puerperium Other obstetric conditions, not elsewhere classified © 2013

Chapter 15 of ICD-10 -CM, Pregnancy, Childbirth and the Puerperium (O 00–O 9 A) • Codes for elective (legal or therapeutic) abortion has been moved to code Z 33. 2, Encounter for elective termination of pregnancy, in Chapter 21 of ICD-10 -CM. • Index entry is o Encounter (for), termination of pregnancy, elective © 2013

Chapter 15 of ICD-10 -CM, Pregnancy, Childbirth and the Puerperium (O 00–O 9 A) • 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 O 00–O 08 © 2013

Chapter 15 of ICD-10 -CM, Pregnancy, Childbirth and the Puerperium (O 00–O 9 A) • 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 © 2013

Coding Instructional Notes for -10 -CM Chapter 15 ICD • 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 © 2013

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 1 st trimester: less than 14 weeks 0 days o 2 nd trimester: 14 weeks 0 days to less than 28 weeks 0 days o 3 rd trimester: 28 weeks 0 days until delivery © 2013

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 Z 3 A, Weeks of gestation, to identify the specific week of pregnancy © 2013

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 © 2013

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 © 2013

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 O 80 © 2013

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 © 2013

Coding Conditions for ICD-10 -CM Chapter 15 • Codes begin with the letter “O”, not zero (0) • Codes include both letters and numbers o O 00 Letter O, 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 © 2013

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 © 2013

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 © 2013

Coding Conditions for ICD-10 -CM Chapter 15 • Pregnancy-Related Codes in Chapter 21, Factors Influencing Health Status and Contact with Health Services o Z 30 Encounter for contraceptive management o Z 31 Encounter for procreative management o Z 32 Encounter for pregnancy test and childbirth and childcare instruction o Z 33 Pregnant state © 2013

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 Z 34 Encounter for supervision of normal pregnancy o Z 36 Encounter for antenatal screening of mother o Z 3 A 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 © 2013

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 Z 37 Outcome of delivery • Codes used as an additional code to identify the outcome of delivery on the mother’s records, to identify the status of the infant as single, twin, or other multiple birth, and whether the infant was liveborn or stillborn o Z 39 Encounter for maternal postpartum care and examination © 2013

Coding Conditions for ICD-10 -CM Chapter 15 • Pregnancy with Abortive Outcome (O 00–O 08) o Pregnancies that end before the completion of 20 weeks of gestation o Ectopic pregnancy (O 00) • Fourth digit identifies the site: abdominal, tubal, ovarian, other • Use additional code to identify any associated complication o Missed abortion (O 02. 1) • Early fetal death before completion of 20 weeks of gestation with retention of dead fetus © 2013

Coding Conditions for ICD-10 -CM Chapter 15 • Pregnancy with Abortive Outcome (O 00–O 08) o Spontaneous abortion (O 03) • 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 © 2013

Coding Conditions for ICD-10 -CM Chapter 15 • Complications Following (induced) Termination of Pregnancy (O 04) o Codes used when a complication occurs after the abortion itself was completed during a previous admission o Excludes 1 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 © 2013

Coding Conditions for ICD-10 -CM Chapter 15 • Failed Attempted Termination of Pregnancy (O 07) 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 Excludes 1 note with O 07 codes states that these codes are not used during an encounter for treatment of an incomplete spontaneous abortions © 2013

Coding Conditions for ICD-10 -CM Chapter 15 • Complications Following Ectopic and Molar Pregnancy (O 08) o Codes used when a complication occurs with an ectopic and molar pregnancy o Category O 08 is used with categories O 00–O 02 to identify any associated complication with the specific conditions included in the fourth-digit level of O 08 © 2013

Coding Conditions for ICD-10 -CM Chapter 15 • Supervision of High Risk Pregnancy (O 09) 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 O 09 o Sixth-character level identifies the trimester of pregnancy when the supervision occurred o Main term “Pregnancy, supervision (of)(for) in Alphabetic Index © 2013

Coding Conditions for ICD-10 -CM Chapter 15 • Threatened Abortion (O 20. 0) o Characterized by bleeding of intrauterine origin before the 20 th 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 © 2013

Coding Conditions for ICD-10 -CM Chapter 15 • Recurrent Pregnancy loss (O 26. 20–O 26. 23, N 96) 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 • N 96 is used if the current hospital admission or encounter does not involve a pregnancy (in the patient) but rather care of a nonpregnant woman with a history of recurrent pregnancy loss © 2013

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 © 2013

Coding Conditions for ICD-10 -CM Chapter 15 • Encounter for Delivery (O 80–O 82) • Category O 80 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, Z 37 category code © 2013

Coding Conditions for ICD-10 -CM Chapter 15 • Encounter for Delivery (O 80–O 82) • Category O 82 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 Z 37 to identify the outcome of delivery © 2013

Coding Conditions for ICD-10 -CM Chapter 15 • Outcome of Delivery (Z codes) o A code from category Z 37, Outcome of delivery, is used on every maternal record when a delivery occurs o Z 37 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” © 2013

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 © 2013

Coding Conditions for ICD-10 -CM Chapter 15 • Preexisting Hypertenion (O 10) o Category O 10, 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 © 2013

Coding Conditions for ICD-10 -CM Chapter 15 • Other Forms of Hypertension, Pre-eclampsia and Eclampsia (O 11–O 16) 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 © 2013

Coding Conditions for ICD-10 -CM Chapter 15 • Excessive Vomiting in Pregnancy (O 21) 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 © 2013

Coding Conditions for ICD-10 -CM Chapter 15 • Late Pregnancy (O 48) 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 O 48. 0 is post-term pregnancy or pregnancy over 40 completed weeks to 42 completed weeks of gestation o O 48. 1 is prolonged pregnancy or pregnancy that has advanced beyond 42 completed weeks of gestation © 2013

Coding Conditions for ICD-10 -CM Chapter 15 • Preterm Labor without Delivery (O 60) 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 Z 37 with O 60 • One patient cannot have both the diagnosis code for an early onset of delivery (O 60) and an elective abortion (Z 33. 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 (O 60). • If pregnancy ends before 20 completed weeks as result of elective abortion and there is a nonviable infant, code is Z 33. 2 © 2013

Coding Conditions for ICD-10 -CM Chapter 15 • Puerperal Sepsis (O 85) and Other Puerperal Infection (O 86) o Puerperal sepsis (O 85) 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 (B 95– B 97) o Additional code is used if severe sepsis is present with or without shock o Other puerperal infection (O 86) 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 © 2013

Coding Procedures in the Obstetrics Section in ICD-10 -PCS • Procedure coding guidelines exist in the Official ICD-10 -PCS Coding Guidelines for obstetrics • Procedures performed on the products of conception are coded to the obstetrics section • Procedures performed on the pregnant female other than on the products of conception are coded to the appropriate root operation in the Medical and Surgical section © 2013

Coding Procedures in the Obstetrics Section in ICD-10 -PCS • Products of conception refer to all components of pregnancy, including o o o fetus embryo amnion umbilical cord placenta • There is no differentiation of the products of conception based on gestational age. © 2013

Coding Procedures in the Obstetrics Section in ICD-10 -PCS • Assigning ICD-10 -PCS Procedure codes for Obstetrics o Character 1—Section, first digit is “ 1” o Character 2—Body system, one choice, pregnancy o Character 3—Root operations • 12 root operations with 10 root operations found in other sections but 2 are unique to OB is abortion and delivery o Character 4—Body part, one choice, products of conception © 2013

Coding Procedures in the Obstetrics Section in ICD-10 -PCS • Assigning ICD-10 -PCS Procedure codes for Obstetrics o Character 5—Approach depends on the root operation, such as open, percutaneous endoscopic, via natural or artificial opening endoscopic and external o Character 6—Specific device of monitoring electrode or other device © 2013

Coding Procedures in the Obstetrics Section in ICD-10 -PCS • Assigning ICD-10 -PCS Procedure codes for Obstetrics o Character 7—Qualifier values dependent on the root operation, approach and body system o Examples are • • • Methods of extraction Methods of terminating pregnancy Substances drained Type of cesarean delivery (classical, low cervical, extraper) Body system involved with repair of anatomical structures of the fetus in utero © 2013

Coding Procedures in the Obstetrics Section in ICD-10 -PCS • Root Operation of “Abortion” o Defined as artificially terminating a pregnancy o Whether additional device is used such as lamineria or abortifacient o Whether the abortion was performed by mechanical means • Root Operation of “Delivery” o Defined as assisting the passage of the products of conception from the genital canal o Includes manually assisted vaginal delivery o Cesarean delivery is NOT coded here but instead to root operation of “extraction” © 2013

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. © 2013