Pregnancy, Childbirth and the Puerperium

HS317b – Coding & Classification of Health Data

O00 – O99 codes

Classify pregnancy with abortive outcome, disorders predominantly related to pregnancy, maternal care, complications of labour and delivery and conditions related to the puerperium

6th digit of the diagnostic code will indicate the episode of care – antepartum, delivery, postpartum

Stages of Pregnancy

Pregnancy with abortive outcomesComplications

Pregnancy – AntepartumComplications

Pregnancy – DeliveryComplications

Pregnancy -- Postpartum

Episode of care – 6th digit

‘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 ‘9’ Unspecified as to episode of care

Gestational Age

Completed weeks after the onset of the last normal menstrual period to delivery

Preterm Less than 37 completed weeks i.e. O60.001 Preterm delivery, delivered, with or

without mention of antepartum condition

Term

37 completed weeks to less than 41 completed weeks

PostTermTraditionally at 42 completed weeks but may

be assigned at 41 weeks if designated by a physician

O48.001 Prolonged pregnancy, delivered, with or without mention of antepartum condition

Trimesters

First trimester < 13th week

Second trimester 14th week—up to an including 26th week

Third trimester > 26 week gestation

Stages of Labour & Delivery

First stage Begins at onset of labour Ends at full dilation of cervix (10 cm)

Second stage Begins at full dilation of cervix Ends at birth of the baby

Third stage Begins at birth of baby Ends at delivery of placenta

Obstetrical Experience Antepartum

Begins at conception Ends at complete dilation of cervix

Intrapartum Begins at complete dilation of cervix Ends at Birth of infant

Postpartum Begins at birth of infant Ends as 42 days after birth of infant

Pregnancy with abortive outcome

Includes codes in the range of O03 – O08 Fourth digit of code

Indicates associated complications

Spontaneous abortion, incomplete, without complications = O03.4

Pregnancy with abortive outcome

Types: Medical Ectopic & Molar Missed Spontaneous Failed Attempt

Ectopic/Molar Pregnancy

Ectopic – pregnancy where fetus develops outside the uterus—in fallopian tubes, cervical canal, abdominal or pelvic cavity

Molar – a tumorous growth of tissue from the placenta or afterbirth

Excludes: malignant hydatidiform mole (D39.2)

Missed abortion Early fetal death before completion of 20 weeks

gestation with retention of dead fetus Excludes mole: hydatidiform (O01.-) and nonhydatidiform

(O02.0)

Spontaneous abortionMiscarriage (premature expulsion of fetus that

occurs naturally and without cause)

Missed or Spontaneous Abortion

Medical abortion O04-O07 Elective & therapeutic

Other abortionSelf-inflicted, occurring after trauma

Failed attempted abortionWhen termination does not result in

terminating the pregnancy

Medical, Other, Failed Abortions

Complications following abortion

ICD-10-CA makes a distinction between an episode of care at which the abortion/ectopic/molar pregnancy and any resulting complications are treated together and an episode of care for a complication of the abortion/ectopic/molar pregnancy treated previously

Ruptured tubal pregnancy with shock (initial episode of care)O00.1 (M) Tubal pregnancyO08.3 (2) Shock following

abortion/ectopic/molar pregnancy

Incomplete spontaneous abortion with perforation of uterus (initial episode of care) O03.3(M) Spontaneous abortion, incomplete, with

other and unspecified complications O08.6 (2) Damage to pelvic organs and tissues

following abortion/ectopic/molar pregnancy

Mrs. S. had a spontaneous abortion and underwent a D & C in the first episode of care. She was brought to ER two days after discharge because she developed a fever and was diagnosed with endometritis.

O08.0(M) Genital tract and pelvic infection following abortion and ectopic and molar pregnancy

Abortion & Sixth digit 9

Sixth digit ‘9’ Can be used for additional OBS conditions with

abortive outcome. Therapeutic abortion because of fetal anomalies

(Trisomy 21) O04.9 (M) Medical Abortion O35.009 (1) Maternal care for chromosomal

abnormalities in fetus.

Delivery in a completely normal case

Normal delivery can includeSpontaneous vertex deliverySingle term livebornHealthy mother deliveredOcciput posterior and occiput transverse not

stated as persistentNo fetal manipulation or instrumentation

Delivery in a completely normal case

(M) Z37.0 Outcome of delivery, single live birth

5.MD.50.~ ~ Manually assisted vaginal delivery (vertex)

Outcome of delivery – Z37.~

Mandatory to code for every delivery When other codes from Chapter XV apply

to the case Z37.~ is classified as a diagnosis type 3.

There must be a corresponding intervention code for delivery selected as your principal procedure

Certain obstetrical procedure do not contraindicate the use of Z37.0 as MRDx Induction for convenience Artificial rupture of membranes Simple manual removal of placenta Episiotomy Requested Cesarean Section in the absence of any

indication

Delivery

Mandatory intervention needed between the range of 5.MD.50.~~ to 5.MD.60.~~ for every delivery. Code as principal procedure

5.MD.50.~~ manually assisted vaginal delivery 5.MD.53.~~ Forceps traction & rotation 5.MD.54.~~ Vacuum traction 5.MD.55.~~ Combo – vacuum & forceps 5.MD.56.~~ Breech delivery 5.MD.60.~~ Caesarean Section

Folio lookup

Pregnancy – – amnionitis O41.19 – – anemia (conditions in D50 D64)

O99.0 – – atrophy (acute) (subacute) (yellow),

liver O26.6 – – bicornis or bicornuate uterus O34.0 – – bone and joint disorders of back,

pelvis and lower limbs O99.8

Pregnancy -conditions in – – – B50 B64, O98.6 – – – D50 D64, O99.0 – – – D65 D89, O99.1 – – – E40 E46, O25 – – – F00 F99, O99.3

Delivery

‘1’ indicates episode in which mother has delivered with or without mention of antepartum conditionAntepartum condition with delivery Intrapartum obstetric conditionDelivery NOSPregnancy, delivered

Sixth Digit Combinations

1 Delivery can be coded with ‘2’ Delivered with complication

3 Antepartum condition can never be coded with ‘1’, ‘2’, ‘4’, or ‘9’

4 Postpartum can never be used with ‘1’, ‘2’, ’3’, or ‘9’

9 should never be used for inpatient care except when the outcome is abortive

Induction and Augmentation of Labour

5.AC.30.~~ Induction of labourAssign when a patient presents for delivery

with no physical signs of labour, and one of these interventions is performed to initiate labour

Mandatory to code

5.LD.31.~~ Augmentation of labour

Assign when labor begins spontaneously Optional to code

Augmentation and induction should not be coded on the same chart Facility directed as to code augmentation & induction

in same episode

Sequencing Obstetrical Dx

If episode of care includes non-instrumental, vaginal delivery of an infant but the mother was admitted for an antepartum condition that required treatment for more than five days before the birth, sequence the antepartum condition as MRDx

In cases within the expected LOS (3 to 5 days) where Caesarean section or instrumentation (forceps or vacuum) has been used, a diagnosis stating the indication for the intervention should be the MRDx

Exclusion/Inclusion notes

O32.1 Maternal care for breech presentationExcludes: the listed conditions with

obstructed labour (O64.-) O64.1 Obstructed labour due to breech

presentation ++

Codes O32-O34 vs O64-O66

Use these codes when mother is diagnosed with these conditions prior to the onset of labour.

When labour has begun, medical intervention is required due to one of the conditions, the case should be classified from the range of O64-O66 Obstructed Labour

Newborn

Code Z38.0~ for every newborn Z38.00 Singleton, born in hospital, delivered

vaginally Z38.01 Singleton, born in hospital, delivered by

caesarean Z38.1 Singleton, born outside hospital Z38.2 Singleton, unspecified as to place of birth

Diagnosis type 0

If there is another contra-indication, Z38.0~ must still be coded but as a diagnosis type 0

No diagnosis type 3 is allowed for newborn coding

Capture Z38 to distinguish babies born via caesarean section from those born vaginally.

Low Birth Weight

Infant delivered by cesarean section at 28 weeks gestation weighing 1700 grams.

When low birth weight is due to prematurity select two codes from P07 Disorders related to short gestation and low birth weight, NEC.

P07.1 (M) Other low birth weight P07.3 (1) Other preterm infant Z38.01 (0) Singleton, born in hospital,

delivered by cesarean section

Low Birth Weight

WHO guidelines state that priority of assignment should be given to birth weight.

Birth weight of less than 2500 grams

Respiratory Distress (RDS) vs Transient Tachypnea (TTN) Newborn diagnosed with respiratory

distress syndrome. Surfactant is not administered. Baby is discharged home on day 3.P22.1 Transient Tachypnea of Newborn.Z38.0~ Singleton, born in hospital…

Standard for P22.0

P22.0 Respiratory Distress Syndromecode when Surfactant is administered and

diagnosis is documented as either RDS or TTN.

Code when baby transferred to higher-level nursery or dies before Surfactant can be administered.

Terminology

APGAR = American Pediatric Gross Assessment Record. It is a scoring system to estimate baby’s general condition at birth, at one minute and at five minutesMeasures baby’s heart rate, breathing, muscle

tone, reflex response and colour GTPAL = Gravida Term Premature Abortion

Live

Classification based on MRDx

MCC 14 Pregnancy and ChildbirthFactors that impact CMG Assignment

Complicating Cesarean Section Previous Cesarean Sections

CMGs 600 - 624

Classification based on MRDx

MCC 15 Newborns and Neonates with Conditions originating in the perinatal periodNo complexity is assigned (level 9)Weight impacts CGM AssignmentCMGs 625 - 648