Health Information Management

Pregnancy codes growing in ICD-10-CM

HIM-HIPAA Insider, March 24, 2014

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The codes for complications of pregnancy, childbirth, and the puerperium appear in Chapter 11 in ICD-9-CM. They move to Chapter 15 in ICD-10-CM. But you will find some more significant changes than just where the codes live.
In ICD-9-CM, you often need a fifth character to denote whether the mother gave birth during the encounter. For example, if a patient is diagnosed with transient hypertension in pregnancy, you would report 642.3x. The fifth digit denotes:
  • 0, unspecified as to episode of care or not applicable
  • 1, delivered, with or without mention of antepartum condition
  • 2, delivered, with mention of postpartum complication
  • 3, antepartum condition or complication
  • 4, postpartum condition or complication
In ICD-10-CM, the codes specify the trimester of the pregnancy in which the condition occurred. For example, if a patient is diagnosed with antepartum transient hypertension (ICD-9-CM code 642.33), you have four choices in ICD-10-CM:
  • O13.1, gestational [pregnancy-induced] hypertension without significant proteinuria, first trimester
  • O13.2, gestational [pregnancy-induced] hypertension without significant proteinuria, second trimester
  • O13.3, gestational [pregnancy-induced] hypertension without significant proteinuria, third trimester
  • O13.9, gestational [pregnancy-induced] hypertension without significant proteinuria, unspecified trimester
Note that the first character is a capital O not a zero. All ICD-10-CM codes start with a letter. However, you may see a zero or two later in some codes.
Coding for multiple fetuses will also present some challenges. ICD-10-CM codes specify the number of fetuses as well as whether the fetuses are monochorionic (share the same placenta) and/or monoamniotic (share the same amniotic sac). The codes are further divided by trimester.
A patient comes in for care related to the fetus and possible delivery problems. She is pregnant with twins and is in her second trimester. Our possible codes include:
  • O30.002, twin pregnancy, unspecified number of placenta and unspecified number of amniotic sacs, second trimester
  • O30.012, twin pregnancy, monochorionic/monoamniotic, second trimester
  • O30.022, conjoined twin pregnancy, second trimester
  • O30.032, twin pregnancy, monochorionic/diamniotic, second trimester
  • O30.042, twin pregnancy, dichorionic/diamniotic, second trimester
  • O30.092, twin pregnancy, unable to determine number of placenta and number of amniotic sacs, second trimester
Note the difference between O30.002 and O30.092. Use O30.002 if the physician does not specify the number of placentas or amniotic sacs. If the physician documents that he or she cannot tell how many there are, use O30.092.
Another aspect worth noting is the seventh character for complications of labor and delivery (O60-O77). The seventh character identifies the fetus involved. If the mom is only carrying one, the seventh character is always 1. That’s pretty easy.
However, if the mother is carrying multiple fetuses, you need to look for documentation that specifies which fetus is affected. For example, if the physician documents obstructed labor due to breech presentation for one twin, he or she needs to specify fetus 1 or fetus 2. If fetus 2 is involved, report O64.1XX2. The base code is only four characters long, so we need two X placeholders to move the seventh character to the seventh position.
We also need to assign a code from category O30 when multiple fetuses are involved.
ICD-10-CM includes codes that specify when a condition, such as hypertension or diabetes, is pre-existing (meaning before the patient became pregnant) and when it is due to the pregnancy.
Codes from Chapter 15 take precedence over codes from other chapters unless the provider documents that the pregnancy is incidental to the encounter. For example, a pregnant woman cuts her hand on broken glass and needs stitches. The injury has nothing to do with pregnancy. The fact that she is pregnant doesn’t impact care unless, for some reason, she would need anesthesia. In this case, you would report the laceration and also report Z33.1 (pregnant state, incidental).
ICD-10-CM also includes Z codes to denote the weeks of gestation. Codes from category Z3A.- are for use, only on the maternal record, to indicate the weeks of gestation of the pregnancy. Code first complications of pregnancy, childbirth, and the puerperium (O00-O9A).
The specified weeks of gestation go from less than eight (Z3A.01) all the way through more than 42 weeks gestation of pregnancy (Z3A.49).
This article originally appeared on HCPro’s ICD-10 Trainer blog.

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