ICD-10 Coding/Pregnancy, Childbirth and the Puerperium

This lesson introduces ICD-10-CM Pregnancy, Childbirth and the Puerperium.

Objectives and Skills

1. Correctly apply ICD-10-CM coding guidelines for accurate selection and sequencing of diagnosis codes commonly used to describe complications of pregnancy, childbirth, and the puerperium
2. Apply ICD-10-PCS coding guidelines for accurate selection of procedure codes commonly used to diagnose and treat complications of pregnancy, childbirth and the puerperium
3. Explain what is included in a normal delivery and what excludes it from being a normal delivery
4. Know and apply key terms from the chapter (i.e. gravida, para, antepartum, peripartum, postpartum, puerperium, etc)
5. Demonstrate use of the proper Z codes when coding outcome of delivery

Guidelines

Part 1: Diagnoses

Chapter 15 Guidelines PowerPoint

Chapter 15 guidelines Introduction video

CG.I.C.15.a.1-6 (General Rules for Obstetrics Cases)

15.a.1 Chapter 15 codes and Sequencying Priority

15.a.2 and 15.a.3 Maternal record only and Final Character for Trimester

15.a.4 and 15.a.5 Selection of Trimester for Inpatient Admissions that Encompass More than One Trimester and Unspecified Trimester

15.a.6 Seventh Character for Fetus Identification

CG.I.C.15.b.1-5 (Selection of OB Principal or First-Listed Diagnosis)

15.b.1 Routine Outpatient Prenatal Visits

15.b.2 Supervision of High-Risk Pregnancy

15.b.3-5 Episode when No Delivery Occurs, When a Delivery Occurs, Outcome of Delivery

CG.I.C.15.c and d (Pre-existing Conditions vs Conditions Due to the Pregnancy and Pre-existing Hypertension in Pregnancy)

15.c and 15.d Pre-Existing Conditions vs Conditions Due to Pregnancy and Pre-Existing Hypertension in Pregnancy

CG.I.C.15.e.1-2 (Fetal Conditions Affecting the Management of the Mother)

15.e.1 and 15.e.2 Codes from Categories O35 and O36 and In Utero Surgery

CG.I.C.15.f (HIV Infection in Pregnancy, Childbirth and the Puerperium)

15.f HIV Infection in Pregnancy, Childbirth and the Puerperium

CG.I.C.15.g, h & i (Diabetes Mellitus in pregnancy, Long Term Use of Insulin and Oral Hypoglycemics and Gestational (Pregnancy Induced) Diabetes)

15.g, h, and i Diabetes Mellitus in Pregnancy, Long Term Use of Insulin and Oral Hypoglycemics and Gestational (Pregnancy-Induced) Diabetes

CG.I.C.15.j and k (Sepsis and septic shock complicating abortion, pregnancy, childbirth and the puerperium and Puerperal sepsis)

15.j and k Sepsis and Septic Shock Complicating Abortion, Pregnancy, Childbirth and the Puerperium and Puerperal Sepsis

CG.I.C.15.l and m (Alcohol, tobacco and drug use during pregnancy, childbirth and the puerperium and Poisoning, toxic effects, adverse effects and underdosing in a pregnant patient)

15.l and m . Alcohol, Tobacco and Drug Use During Pregnancy, Childbirth and the Puerperium Poisoning and Toxic Effects, Adverse Effects and Underdosing in a Pregnant Patient

CG.I.C.15.n.1-3 (Normal Delivery, Code O80)

15.n.1-3 Encounter for Full Term Uncomplicated Delivery, Uncomplicated Delivery with Resolved Antepartum Complication and Outcome of Delivery for O80

CG.I.C.15.o.1-5 (The Peripartum and Postpartum Periods)

15.o.1-3 Peripartum and Postpartum Periods, Peripartum and Postpartum Complication and Pregnancy-Related Complications after 6 Week Period

15.o.4 and 5 Admission for Routine Postpartum Care Following Delivery Outside Hospital and Pregnancy Associated Cardiomyopathy

CG.I.C.15.p.1-3 (Code O94, Sequelae of Complication of Pregnancy, Childbirth, and the Puerperium)

15.p.1-3 Code O94, After the initial postpartum period and Sequencing of Code O94

CG.I.C.15.q.1-3 (Termination of Pregnancy and Spontaneous Abortions)

15.q.1-3 Abortion with Liveborn Fetus, Retained Products of Conception following an abortion, and Complications leading to abortion

CG.I.C.15.r (Abuse in a pregnant patient)

15.r Abuse in Pregnant Patient

***Some examples can be found in your Coding Clinic here:

ICD-10-CM/PCS Coding Clinic®, Fourth Quarter 2016 Pages: 125-126 and 150

ICD-10-CM/PCS Coding Clinic®, First Quarter 2016 Pages: 3-6

Part 2: Procedures

https://www.cms.gov/Medicare/Coding/ICD10/2019-ICD-10-PCS.html(Official 2019 PCS coding guidelines and Code Tables and Index)

ICD-10-PCS Procedure coding Obstetrics guidelines

PCS Obstetrics Guidelines video

Vacuum assisted delivery

Obstetric Procedure Case Examples

Procedure Examples 1 & 2

Procedure Examples 3 & 4

Procedure Examples 5 & 6

Procedure Example 7

Procedure Example Lacerations

Procedure Example Ectopic

Ectopic Pregnancy

Learning Resources

ICD-10-CM Pregnancy and Childbirth Bootcamp

Demonstration of Stages of delivery

HTN in Pregnancy

Gestational Diabetes

Pre-existing diabetes and pregnancy

Activities

Quizlets for Chapter 15 Guidelines:

https://quizlet.com/_68g0tq (Chapter 15 Guidelines - General rules for Obstetric Cases)

https://quizlet.com/_68gd67 (Chaapter 15 Guidelines - selection of OB Principle or First-listed Diagnosis)

https://quizlet.com/_68go3d (Chapter 15 Guidelines - pre-existing HTN, fetal conditions affecting mom, HIV, Diabetes)

https://quizlet.com/_68h1m4 (Chapter 15 Guidelines - sepsis, alcohol/tobacco, poisoning & normal delivery)

https://quizlet.com/_68hcgx (Chapter 15 Guidelines - Peripartum/Postpartum, Sequelae, termination/abortions)

Quizlets for Key Terms/Pregnancy Cheat Sheet:

https://quizlet.com/_68hzlm (Important Chapter 15 Key Terms)

https://quizlet.com/_68ia13 (Normal Delivery (O80) Notes & Important Z codes)

Lesson Summary

Review:

Chapter 15 General Guideline Assessment

Chapter 15 Selection of OB principal and first listed diagnosis Assessment

Chapter 15 Pre-existing HTN & More Assessment

Chapter 15 Sepsis & More Assessment

Chapter 15 Peripartum & More Assessment

• Important Chapter 15 vocabulary (see Key Terms)
• Diagnosis Guidelines and Code Scenarios (see Guidelines and Coding Examples)
• Procedure Guidelines and Code Scenarios (see Guidelines and Coding Examples)

Key Terms

Pregnancy Trimesters

Trimesters (majority of codes in Ch. 15 have a final character for trimester)

• 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 to delivery

7th Character to Identify Fetus:

0 – single gestation, documentation on record is insufficient and unable to clarify or not clinically possible to determine which fetus)

1 – Fetus 1

Fetus 1, Fetus 2

2 – Fetus 2

3 – Fetus 3

4 – Fetus 4

5 – Fetus 5

9 – Other fetus

Peripartum and Postpartum Periods

Postpartum Period: Begins immediately after delivery and continues for 6 weeks

Peripartum Period: the last month of pregnancy to 5 months postpartum

Postpartum Complication: Any complication occurring within the 6 week window after delivery

References

Information on Gestational Diabetes

Information on HIV/AIDS and pregnancy

Information on Sepsis and pregnancy

2019 ICD-10-CM/PCS Medical coding reference

Questions on OB cases answered

Coding tips: Pregnancy

ICD 10-CM Wiki Page