Chapter 15 – ( chapter 24 – Chisen ) ICD 10 Pregnancy-Childbirth, and the Puerperium

Conditions affecting the management of pregnancy, childbirth, and the puerperium are classified in chapter 15 of ICD-10-CM
categories O00-O9A
Conditions from other chapters are reclassified in chapter 15 when related to
aggravated by the pregnancy, childbirth, or the puerperium.
Pregnant state, incidental, if pregnancy is incidental to the encounter
Assign code Z33.1
Chapter 15 codes refer to the mother only
Used only on the mother’s record.
Never assigned on the newborn’s record.
Ectopic pregnancy;
Molar pregnancy; and
Abortion.
Categories O00-O08 are assigned for pregnancy with abortive outcome, including:
From conception until six weeks 42 days after delivery
Use codes in categories O09-O9A throughout the obstetrical experience:
Three stages of labor and delivery
First stage-second stage-third stage
First Stage
Onset of contractions
Complete dilation of cervical os
Second stage
Complete dilation and expulsion of infant
Third stage
Expulsion of placenta and membranes
Completed contraction of the uterus
Puerperium
End of the third stage of labor; and continues for six weeks
First trimester
Less than 14 weeks 0 days
Second trimester
14 weeks 0 days to less than 28 weeks 0 days
Third trimester
28 weeks 0 days until delivery
Final Character to Indicate Trimester
Assign the trimester at the time of the encounter for conditions developing prior to the current encounter or for pre-existing conditions.
Use the date of admission
to determine weeks of gestation for inpatient admissions involving more than one week
Unspecified trimester code is rarely used.
Only used when documentation is insufficient; and
When it is impossible to obtain clarification.
Weeks of gestation, provide additional information.
Codes in category Z3A
Term pregnancy
Gestation 37 weeks but less than 42 weeks.
Outcome of Delivery
Code from category Z37 is assigned as additional code whenever patient delivers in the hospital.
Fourth characters indicate outcome of delivery:
Single or multiple
Liveborn or stillborn
For multiple births (more than twins), additional characters indicate the number of outcomes (e.g., triplets, quadruplets.
For example, liveborn, some liveborn, or all stillborn:
Used only on the mother’s record.
Not used for the newborn record.
Do not assign codes from category Z37 when delivery occurs outside the hospital prior to admission.
Fetal Seventh Characters
Some obstetric subcategory codes require a seventh character to identify the fetus for which the complication code applies.
Seventh characters “1” through “9” apply in cases of multiple gestations to identify the fetus for which the code applies.
Seventh character “0” (not applicable or unspecified) only used for the following situations:
Single gestations
When the documentation is insufficient to determine the fetus affected and it is not possible to obtain clarification
Clinically impossible to determine which fetus is affected
Fetal Seventh Characters
Assign codes in category O30, Multiple gestation, when using a seventh character of “1” through “9.”
Review the Tabular List for assignment of the correct seventh character for multiple gestations.
Some providers refer to each fetus by alphabetical characters (e.g., fetus A, fetus B, etc.)
Fetus A equated to fetus 1.
Fetus B equated to fetus 2, etc.
No expectation that the same fetus number or alphabetical character be consistently carried over from one admission to another.
Identification of the fetus is based on provider documentation.
Encounter for supervision of normal pregnancy, for routine outpatient prenatal visits with no complications
Assign a code from category Z34.The category Z34 code is the first-listed diagnosis.This code is not used in conjunction with chapter 15 codes
Supervision of high risk pregnancy, as the first-listed diagnosis for routine prenatal outpatient visits for patients with high-risk pregnancies.
Use category O09.Chapter 15 codes can be assigned in conjunction with category O09 codes.
Encounter for full-term uncomplicated delivery:
Assign code O80
As principal diagnosis only.
Code O80 indicates:
Normal delivery
Single liveborn outcome
No postpartum complications, and
Any antepartum complications resolved before delivery
If multiple birth or stillbirth
code O80 is not assigned.
Selection of Principal Diagnosis
For cesarean delivery, the principal diagnosis is the condition established after study responsible for the admission.
If admitted with a condition that resulted in a cesarean, that condition is the principal diagnosis.
If the reason for encounter is unrelated to the condition resulting in the cesarean delivery, the condition related to the reason for the encounter is selected as the principal diagnosis, even if a cesarean was performed.
Encounter for cesarean delivery without indication.
assign code O82
To describe a planned cesarean delivery when the onset of labor occurs after 37 weeks, but before 39 weeks.
Assign code O75.82
Maternal Care for Fetal Problems- or suspected fetal abnormality and damage
code O35,
Maternal care for other fetal problems-Used only when the fetal condition modifies or affects the mother’s care e.g., additional diagnostic studies, additional observation, special care, and/or termination of the pregnancy
code 036
for encounter for fetal viability if:
Provider is unable to determine fetal viability or nonviability.
Previously confirmed pregnancy is currently without fetal heartbeat.
code O36.80
Multiple gestation, identifies multiple gestation:
Category O30,
Twin (O30.001-O30.099);
Triplet (O30.101-O30.199);
Quadruplet (O30.201-O30.299);
Other multiple gestations (O30.801-O30.899); and
Unspecified (O30.90-O30.93)
Complications increase and treatment plans differ depending on the number of placentas and amniotic sacs:
Fifth characters indicate the number of placentas and amniotic sacs.
Sixth characters indicate the trimester.
In utero surgery
is an obstetric encounter.
Do not use chapter 16 perinatal codes on the mother’s record to identify fetal conditions..
Maternal care for known or suspected fetal abnormality and damage, when in utero surgery is performed on the fetus.
Assign category O35 Assign the appropriate ICD-10-PCS code for the procedure.
Maternal care for suspected damage to fetus by other medical procedures, for complications resulting from in utero surgery or for supervision of pregnancy affected by in utero procedure during current pregnancy.
Assign code O35.7-
In utero surgery
ICD-10-PCS classifies in utero surgery to the Obstetrics Section, body system “pregnancy,” root operation “Repair,” body part “products of conception.”
For patients with a past history of in utero surgery during a previous pregnancy:
Supervision of pregnancy with history of in utero procedure during previous pregnancy
Assign code O09.82
Pre-existing Conditions
Some conditions complicate or aggravate the pregnancy.
Categories in chapter 15 of ICD-10-CM distinguish between pre-existing conditions and those occurring as a result of pregnancy.
When assigning codes from chapter 15, determine whether a condition was pre-existing or developed due to the pregnancy.
Categories not distinguishing between pre-existing or pregnancy-related conditions may be used for either.
It is acceptable to use puerperium codes with codes complicating pregnancy and childbirth if a condition develops postpartum during the delivery episode.
Pre-existing Hypertension
For hypertension in pregnancy, childbirth, or the puerperium, determine if the hypertension is pre-existing or gestational.
Pre-existing hypertension is classified to category O10 as follows:
O10.01-O10.03 Essential hypertension
O10.111-O10.13 Hypertensive heart disease
O10.211-O10.23 Hypertensive chronic kidney disease
O10.311-O10.33 Hypertensive heart and chronic kidney disease
O10.411-O10.43 Secondary hypertension
O10.911-O10.93 Unspecified
Hypertension during pregnancy.
Patients can develop transient, gestational, or pregnancy-induced hypertension during pregnancy.
Hypertension in pregnancy can lead to eclampsia with a high level of protein in the urine:
Occurs when preeclampsia is untreated.
Causes seizures, coma, or death.
Gestational pregnancy-induced hypertension without significant proteinuria.
Assign category O13,
Pre-eclampsia, superimposed on pre-existing hypertension
is assigned to category O11, with a category O10 code to identify the type of hypertension.
Without pre-existing hypertension
assign category O14.
Eclampsia is classified to category O15.
Diabetes mellitus in pregnancy, childbirth, and the puerperium, for pregnant women who are diabetic:
Assign category O24
Followed by the appropriate diabetes code(s) (E08-E13).
Gestational (pregnancy induced) diabetes (O24.4-) occurs during the second and third trimester.
Causes complications similar to pre-existing diabetes mellitus.
Assign code Z86.32 to indicate history of gestational diabetes in a previous pregnancy.
Assign subcategory O99.81, Abnormal glucose complicating pregnancy, childbirth, and the puerperium, to describe abnormal glucose tolerance without a diagnosis of gestational diabetes.
HIV and Pregnancy, to identify human immunodeficiency [HIV] disease complicating pregnancy, childbirth and the puerperium:
Followed by the code(s) for the HIV‑related illness(es).
Assign subcategory O98.7-
Asymptomatic human immunodeficiency virus [HIV] infection status, for patients with asymptomatic HIV infection during pregnancy.
Assign codes O98.7- and Z21,
Alcohol and Tobacco Use in Pregnancy
Assign codes from subcategory O99.31 to describe alcohol use during the pregnancy.
Assign a secondary code to identify manifestations of alcohol use.
From category F10
Smoking (tobacco) complicating pregnancy, childbirth, and the puerperium, for tobacco use during the pregnancy.
Assign subcategory O99.33
Nicotine dependence
assign also category F17
Complications of labor and delivery
Categories O60-O77
Never assigned with code O80, Encounter for full-term uncomplicated delivery.
Obstructed labor occurs when the passage of the fetus through the pelvis is obstructed due to disproportion between the fetus’s head and the mother’s pelvis.
Can be caused by malpresentation, malposition, and/or fetal abnormalities
Preterm labor: “onset (spontaneous) of labor before 37 completed weeks of gestation.”
Category O60
Includes with and without delivery.
Should not be used with codes from subcategory O47.0- for false or threatened labor.
Failed induction of labor:
Category O61.
Fourth characters distinguish between medical, instrumental, other, and unspecified methods of induction of labor.
Complications of Labor and Delivery
Abnormalities of forces of labor are classified to category O62.
Fourth characters specify primary inadequate contractions (O62.0); secondary uterine inertia (O62.1); other uterine inertia (O62.2); precipitate labor (O62.3); hypertonic, incoordinate, and prolonged uterine contractions (O62.4); other abnormalities of labor (O62.8); and unspecified abnormalities of labor (O62.9).
Prolonged labor: Category O63
Fourth character specifies the stages: prolonged first stage (O63.0); prolonged second stage (O63.1); delayed delivery of second twin, triplet, etc. (O63.2); and unspecified (O63.9).
Obstructed labor due to different etiologies:
Category O64 is used to describe labor that may be obstructed due to the position of the fetus.
Category O65 is used to report obstructed labor caused by an abnormality in the mother’s pelvis.
Category O66 is used to classify other reasons for obstructed labor
Fetal Distress
Category O68, Labor and delivery complicated by abnormality of fetal acid-base balance, describes fetal acidemia, fetal acidosis, fetal alkalosis, or fetal metabolic acidemia.
Category O76, Abnormality in fetal heart rate and rhythm complicating labor and delivery, includes fetal problems such as bradycardia, heart rate decelerations, heart rate irregularity, tachycardia, and non-reassuring fetal heart rate or rhythm.
Category O77, Other fetal stress complicating labor and delivery, includes codes for meconium in amniotic fluid (O77.0), fetal stress due to drug administration (O77.1), and other evidence of fetal stress (O77.8).
Postpartum Complication
The postpartum period occurs after delivery up to 6 weeks.
Any complication occurring during the six-week period is coded to categories O85-O92.
Puerperal infection—a bacterial infection following childbirth.
Genital tract is most common site (e.g., endometritis [O86.12]).
Other types of puerperal infections include:
Infection of obstetrical surgical wound (O86.0)
Cervicitis (O86.11)
Vaginitis (O86.13)
Other infection of genital tract (O86.19)
Urinary tract infection (O86.20)
Postpartum Complication
Infection of kidney (O86.21)
Infection of bladder (O86.22)
Other urinary infection (O86.29)
Pyrexia of unknown origin (O86.4)
Puerperal septic thrombophlebitis (O86.81)
Other specified puerperal infections (O86.89)
O85, Puerperal sepsis, requires secondary code for causal organism.
Severe sepsis: assign also R65.2- and code for associated acute organ dysfunction.
Uterine atony
Refers to failure of the uterine muscle to contract adequately after delivery.
Can occur with or without bleeding.
Assign code O62.2, Other uterine inertia, for atony of the uterus without hemorrhage immediately following delivery.
Assign code O72.1, Other immediate postpartum hemorrhage, for postpartum uterine atony with hemorrhage immediately following delivery.
Use code O75.89, Other specified complications of labor and delivery, for postpartum uterine atony without hemorrhage.
Conditions Complicating Pregnancy, Childbirth, and the Puerperium
Assign code O90.3 when cardiomyopathy develops as a result of pregnancy in women without pre-existing heart disease.
Assign code O99.4, Diseases of the circulatory system complicating pregnancy, childbirth and the puerperium, for pre-existing heart disease complicating pregnancy.
Category O99 describes other maternal diseases classifiable elsewhere but complicating pregnancy, childbirth, and the puerperium. Category O99 includes conditions that complicate the pregnant state or aggravate pregnancy:
O99.0- Anemia
Conditions Complicating Pregnancy, Childbirth, and the Puerperium
O99.1- Other diseases of the blood and blood-forming organs and certain disorders involving the immune mechanism
O99.2- Endocrine, nutritional, and metabolic diseases
O99.3- Mental disorders and diseases of the nervous system
O99.4- Diseases of the circulatory system
O99.5- Diseases of the respiratory system
O99.6- Diseases of the digestive system
O99.7- Diseases of the skin and subcutaneous tissue
O99.8- Other specified diseases and conditions
Malignant Neoplasms Complicating Pregnancy
Subcategory O9A.1, Malignant neoplasms complicating pregnancy, childbirth, and the puerperium, classifies malignancy in pregnancy.
Assign also additional code(s) to identify the specific neoplasm (subcategories C00-C96).
Maternal care for benign tumor of corpus uteri is coded to O34.1-.
Maternal care for benign tumor of cervix is classified to O34.4-.
Sequelae of Pregnancy
When an initial obstetric complication develops a sequela that requires care or treatment at a later date:
Assign code O94, Sequelae of complication of pregnancy, childbirth, and the puerperium.
Sequelae includes:
Late effects occurring any time after the postpartum period.
Code O94 is sequenced after the code describing the residual condition.
Obstetrical Procedures
Obstetrical procedures in ICD-10-PCS distinguish between procedures performed on the fetus or the pregnant female.
Procedures performed on the fetus (products of conception) are classified to the Obstetrics Section.
Procedures performed on the pregnant female (other than the products of conception) are coded to the appropriate root operation in the Medical and Surgical Section.
The body system (character 2) is always “pregnancy.”
There are three values used for body part: “products of conception” (0); “products of conception, retained” (1); and “products of conception, ectopic” (2).
Obstetrical Procedures
Two root operations are unique to the Obstetrics Section:
Abortion: Artificially terminating a pregnancy
Delivery: Assisting the passage of the products of conception from the genital tract
Applies only to manually assisted, vaginal delivery.
Obstetrics Section, root operation “Extraction,” used for:
Cesarean deliveries
Vaginal deliveries requiring forceps, vacuum, or internal version
Procedures following delivery or abortion, such as:
Curettage or evacuation of retained products of conception (body part “products of conception, retained”)
Obstetrical Procedures
Diagnostic or therapeutic dilation and curettage performed during times other than the postpartum or post-abortion period:
Coded in the Medical and Surgical Section to the root operation “Extraction” and the body part “endometrium.”
Procedures Assisting Delivery
Labor induction by artificial rupture of membranes:
Medical and Surgical Section, root operation “Drainage,” body part “amniotic fluid,” or
By other surgical induction (cervical dilatation).
Amnioinfusion: Administration Section, root operation “Introduction”
Prophylactic treatment of oligohydramnios
Reduction of variable decelerations of the fetal heart rate
Treatment of preterm premature rupture of membranes
Forceps and Vacuum Extraction
Forceps assist delivery
Coded to the Obstetrics Section, root operation “extraction”
Low-forceps delivery (7th-character qualifier value “3”)
Mid-forceps (7th-character qualifier value “4”)
High forceps (7th-character qualifier value “5”)
Breech presentations require:
Partial or total breech extraction, with or without forceps to the aftercoming head
Vacuum extraction (7th-character qualifier value “6”) uses a traction device rather than forceps.
Episiotomy and Perineal Laceration
Episiotomy is a surgical incision in the perineum, enlarging the vaginal opening to assist delivery.
Episiorraphy (repair) is not coded separately.
Repair is integral to the procedure.
Episiotomy with forceps delivery requires two codes:
Code forceps delivery as well as the episiotomy.
For perineal lacerations classified as first, second, third, or fourth degree, assign category O70 codes.
An episiotomy can extend to become a perineal laceration or tear.
Assign a code for the episiotomy, along with a code for repair of perineal laceration.
Cesarean Delivery
Operative delivery is carried out when, for some reason, spontaneous delivery is not possible or advisable.
Cesarean sections are classified to the root operation “Extraction,” body part “products of conception,” and open approach.
Extraperitoneal cesarean section is identified with seventh-character qualifier value “2.”
Contraceptive Management
Category Z30 describes encounters for the purpose of contraceptive management.
Codes in this category cover the following services:
Initiation of oral contraceptive measures (Z30.011);
Counseling in natural family planning to avoid pregnancy (Z30.02);
Insertion of intrauterine contraceptive device (Z30.430);
Removal of intrauterine contraceptive device (Z30.432);
Removal and reinsertion of intrauterine contraceptive device (Z30.433);
Sterilization (Z30.2); and
Surveillance of injectable contraceptive (Z30.42)
Contraceptive Sterilization
Assign code Z30.2 for encounters for the purpose of contraceptive sterilization.
Assign also codes for any underlying medical or psychological conditions, if applicable.
If elective sterilization is performed during hospital episode for obstetrical delivery, assign code Z30.2 as an additional code along with a chapter 15 code.
Assign code Z30.2 for both female and male sterilization.
Sterilization is also referred to as tubal ligation:
Surgical procedure to cut fallopian tubes, or coagulated, clipped (e.g., Filshie clip), cauterized, or blocked with an external ring (e.g., Falope ring)
Root operations “Occlusion,” “Excision,” or “Destruction”
Contraceptive Sterilization
Sterilization procedures for males are classified to the male reproductive system, root operations “Destruction” or “Excision.”
Code Z30.2 is not assigned when sterilization results from other treatment; or
When a sterilization procedure is performed as part of the treatment for another condition.
Assign codes for the original condition, any complications or comorbidities, and code the procedures as well.
Sterilization procedures are usually permanent.
However, reversal of the sterilization procedure is coded Z31.0, Encounter for reversal of previous sterilization.
Procreative management
Assign category Z31, Encounter for procreative management, for patients having difficulty becoming pregnant.
Assign code Z31.61 for encounters for procreative counseling and advice using natural family planning.
Use code Z31.62, Encounter for fertility preservation counseling, to describe encounters for advice and counseling on available options to conceive a child or maintain pregnancy before the start of cancer treatment or the surgical removal of gonads.
Use code Z31.84, Encounter for fertility preservation procedure, for fertility preservation encounters
Procreative management
Assign code Z31.83 for patients undergoing in vitro fertilization.
Assign an additional code to identify the type of infertility.
Code Z31.83 is not used for encounters for diagnostic testing prior to starting in vitro fertilization.
Assign the reason for the encounter when the patient presents for diagnostic testing.
Assign code Z31.41 for encounters for investigations such as sperm counts or fallopian tube insufflation.
Assign code Z31.42 for encounters for sperm count following sterilization reversal.
Encounters for Testing and Counseling for Genetic Disease
Codes Z31.430, Z31.438, Z31.440, Z31.441, Z31.448, and Z31.5 describe encounters for testing and counseling for genetic disease.
If the encounter for genetic screening is not associated with procreative management:
Assign a code from subcategory Z13.7, Encounter for screening for genetic and chromosomal anomalies, rather than a code from the Z31.4- series.
Encounter for Suspected Maternal or Fetal Condition
Codes from subcategory Z03.7 are used in limited circumstances on a maternal record when an encounter for a suspected maternal or fetal condition is ruled out.
Not used when the condition is confirmed; rather, code the confirmed condition.
Not used if signs or symptoms are related to the suspected condition or problem present.
Codes for the diagnosis/sign or symptom are reported instead.
Use codes from subcategory Z03.7, along with other codes, when the encounter is unrelated to the suspected condition being evaluated.
Subcategory Z03.7 is not used for encounters for antenatal screening of the mother.