ICD-10-CM CHAPTER 18

O
what letter do codes begin with?
MATERNAL
what record do we use O codes in?
1st trimester
up to less than 14 weeks
2nd trimester
14 weeks to 28 weeks
3rd trimester
28 weeks-delivery
final
what character indicates trimester?
should be based on the provider’s documentation of the trimester (or number of weeks) for the current admission/encounter.
“in childbirth”
whenever delivery occurs during the current admission, and there is an “in childbirth” option for the obstetric complication being coded, what code should be assigned?
2nd
if women has complication at the end of 2nd trimester but is discharged 3rd trimester, which trimester do you code for?
trimester condition developed, NOT trimester of discharge.
if patient is admitted for a condition that develops in one trimester and is discharged in another trimester, which trimester do you code for?
Z33.1
pregnancy incidental to encounter.
states patient is pregnant and condition being treated is not affecting the pregnancy.
Z3A
identifies week of gestation. coded on every chart.
Z37
outcome of delivery. should be included on every maternal record when a delivery has occurred.
identify the status of the infant, single, twin or other multiple births, and whether the infant was liveborn or stillborn.
**ALWAYS ADDITIONAL DIAGNOSIS CODE**
Z34
code for routine outpatient prenatal visits when no complications are present.
O code
always have to code what code first?
ectopic pregnancy
pregnancy occurs anywhere but uterus.
fourth digit identifies the site: abdominal, tubal, ovarian, other
missed abortion
early fetal death before completion of 20 weeks of gestation with retention of dead fetus
Spontaneous abortion
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.
COMPLETE VS INCOMPLETE
complete abortion
expulsion of all of the products of conception from the uterus prior to the episode of care.
incomplete abortion
expulsion of some, but not all, of the products of conception from the uterus.
O09.5-.6
elderly pregnant females (35+)
young pregnant females (younger than 16)
complete abortion
complications following induced termination of pregnancy (O04)
codes used when a complication occurs after the abortion itself was completed during a previous admission.
**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**
4th digit identifies the specific complication
failed attempted termination of pregnancy (O07)
codes used when attempted abortion fails and pregnancy continues. may not produce any complication.
4th digit identifies when complication occurs.
**NOT USED DURING AN ENCOUNTER FOR TREATMENT OF AN INCOMPLETE SPONTANEOUS ABORTIONS)
late pregnancy (048)
codes to identify women who are beyond 40 completed weeks of gestation.
not considered prolonged until 42 weeks
complications following ectopic and molar pregnancy (O08)
codes used when a complication occurs with an ectopic and molar pregnancy.
**USED WHEN CATEGORIES O00-O02 to IDENTIFY ANY ASSOCIATED COMPLICATION WITH SPECIFIC CONDITIONS INCLUDED IN FOURT DIGIT LEVEL OF O08**
supervision of high risk pregnancy (O09)
codes may be used as principal, first listed or an additional diagnosis code.
for routine prenatal outpatient visits for patients with high risk pregnancies.
6th character identifies the trimester of pregnancy when supervision occurred
threatened abortion (O20.0)
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.
LOSS OF PREGNANCY IS PREVENTED AND THE PATIENT REMAINS PREGNANT AT THE END OF ADMISSION OR ENCOUNTER
recurrent pregnancy loss (O26.20-O26.23, N96)
known as habitual or recurrent abortion.
defines the spontaneous expulsion of a dead or nonviable fetus in two or more pregnancies at any gestational age.
N96
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.
pregnancy
state of a female after conception until birth (deliver) of the child
preterm delivery
before 37 completed weeks, but at least 20 completed weeks
term delivery
between 38-40 completed weeks
post term delivery
between 41 and 42 completed weeks
prolonged
advanced beyond 42 completed weeks
immediately after delivery and continues for 6 weeks
when does postpartum or puerperium period begin?
examples of pregnancy complications
Edema, proteinuria and hypertensive disorders
Maternal care related to fetus and amniotic cavity
Complications of labor and delivery
Complications predominantly related to the puerperium
preexisting hypertension (O10.0)
includes any condition in (I10) specified as the reason for obstetric care during pregnancy, childbirth, or the puerperium.
casual organism
Puerperal sepsis, should be assigned with a secondary code to identify the _____________.
F17
Z72.0
tobacco use during pregnancy code O99.33 should be coded along with secondary code ______ to identify the type of nicotine dependence.
F10
alcohol use during pregnancy code O99.31 should be coded along with secondary code ____ to identify manifestations of the alcohol use.
preexisting secondary hypertension (O10.4)
includes any condition in (I15) specified as a reason for obstetric care during pregnancy, childbirth, or the puerperium.
**use additional code from I15 to ID the type of secondary hypertension**
FURTHER SUBDIVIDIED BASED UPON TRIMESTER ,CHILDBIRTH, OR PUERPERIUM
preexisting hypertensive heart disease (O10.1-)
includes any condition in (I11) specified as a reason for obstetric care during pregnancy, childbirth, or the puerperium.
**use additional code from I11 to identify the type of hypertensive heart disease
preexisting hypertensive chronic kidney disease (O12.2-)
includes any condition in I12 specified as a reason for obstetric care during pregnancy, childbirth, or the puerperium.
**use an additional code from I12 to identify the type of hypertensive chronic kidney disease
preexisting hypertensive heart and chronic kidney disease (O10.3-)
includes any condition in I13 specified as a reason for obstetric care during pregnancy, childbirth, or the puerperium.
**use an additional code from I13 to identify the type of hypertensive heart and chronic kidney disease
gestational hypertension
refers to hypertension with an onset in the latter part of pregnancy without any other features of pre-eclampsia and followed by normalization of the blood pressure postpartum.
pre-eclampsia (O14)
high blood pressure (140/90 higher)
protein in the urine
eclampsia (O15.-)
life threatening complication of pregnancy, results when a pregnant woman, previously diagnosed with pre-eclampsia develops seizure or coma.
*severe headache*
*blurred or double vision*
*seeing spots*
hyperemesis
excessing vomiting
hyperemesis gravidarum
severe morning sickness
*mild
*with metabolic disturbance
*late vomiting of pregnancy
*vomiting of pregnancy, unspecified
genitourinary tract infections (O23)
UTIs: one of the most common bacterial infections during pregnancy
*associated with risks to both the fetus and the mother, which include pyelonephritis, preterm birth, low birth weight, and increased perinatal mortality.
**BASED ON SITE AND TRIMESTER**
**USED ADDITIONAL CODE TO IDENTIFY THE ORGANISM**
preexisting diabetes (O24)
increased risk for having a big baby, baby who has hypoglycemia and a baby who has jaundice
type of diabetes
time of occurrence
what are preexisting diabetes broken down by?
gestational diabetes
starts when the body is not able to make and use all the insulin it needs for pregnancy. without enough insulin, glucose cannot leave the blood and be changed to energy.
insulin-controlled
if patient with gestational diabetes is treated with both diet-controlled and insulin-controlled, only the code for what is required?
multiple gestation (O30)
twins, triplets, quadruplets
O31
what category is used for complications specific to multiple gestations?
monochorionic
twins who share the same placenta
dichorionic
twins who develop in separate sacs. all fraternal twins are dichorionic
conjoined twins
identical twins who did not fully separate from one another and are still partially united
7th
what character is used to identify the specific fetus when a complication occurs.
coding pre-eclampsia,
stated trimester,
single, twins, etc;
weeks of gestation
O14.- O30.- Z3A-
abnormalities in fetal heart rate and rhythm (O76)
depressed fetal heart tones, fetal bradycardia, fetal heart rate decelerations, fetal heart rate irregularity, fetal heart rate abnormal variability, non-reassuring fetal heart rate or rhythm.
uncomplicated delivery (O80)
normal delivery: full term, healthy, single, liveborn infant, no antepartum complications, no complications during delivery, no complications after delivery, heart first position, vaginal, with or without episiotomy, without fetal manipulation or instrumentation.
**MUST BE ACCOMPONIED BY A DELIVERY CODE**
**USE ADDITIONAL CODE TO INDICATE THE OUTCOME OF DELIVERY**
(NO OTHER O CODES CAN BE ASSIGNED WITH THIS CODE)
encounter for cesarean delivery (O82)
no documented indication.
**MUST BE ACCOMPANIED BY A DELIVERY CODE**
**USE ADDITIONAL CODE TO INDICATE OUTCOME OF DELIVERY**
postpartum complication
any complication occurring within the six-week period
puerperium period
last month of pregnancy to five months postpartum.
Puerperal Sepsis (O85)
one of the most serious manifestations of major postpartum infection, complication occurs during the 6 weeks or 42 days following delivery
**USE ADDITIONAL CODE TO IDENTIFY INFECTIOUS AGENT** B95-B97
Z39.0
when a mother delivers outside of the hospital prior to admission and is admitted for routine postpartum care and no complications are noted, code?
Other puerperal infection (O86)
identifies localized infections that occur during the postpartum period such as infection of obstetric surgical wound, other infection of genital tract, UTI, and other conditions
HIV (O98.7)
during pregnancy, childbirth, or puerperal a patient admitted because of HIV related illness should receive principal diagnosis from ____ ? FOLLOWED BY CODE FOR _______________
Z21
patients with an asymptomatic HIV infection status admitted during pregnancy, childbirth, or the puerperium should receive codes of O98.7- and what code?
mental disorders (O99.3)
utilize these codes (subcategory O99.34-) to code other mental disorders classifiable to F01-F09 and F20-F99
other specified (O99.8)
other specified diseases and conditions complicating pregnancy, childbirth and the puerperium
**USE ADDITIONAL CODE TO IDENTIFY THE CONDITION**
streptococcus B-carrier state
O99.82-
carrying strep B, but doesn’t have active infection.
pregnancy related Z codes
Z30: encounter for contraceptive management
Z31: encounter for procreative management
Z32: encounter for pregnancy test and childbirth and childcare instruction
Z33: pregnant state
Z34: encounter for supervision of normal pregnancy
Z36: encounter for antenatal screening of mother
Z3A: weeks of gestation
Z37: outcome of delivery
Z39: encounter for maternal postpartum care and examination
postpartum period
begins immediately after delivery and continues for six weeks following delivery.
O60.1
Z37.
when an attempted termination of pregnancy results in a liveborn fetus, assign a code from subcategory ____ and a code from ____
Z33.2
code for encounter for uncomplicated elective termination of pregnancy.
Z36
code used to describe the encounter for antenatal or prenatal screening of the pregnant female.
O03 (spontaneous abortion)
what codes are used to classify abortion complications that arise during an admission and encounter?
O04
what codes are used to classify abortion complications that result following abortion completed during a previous admission?
O09 (supervision of high risk pregnancies)
what codes are assigned for prenatal visits in high risk pregnancies?