FEATURED ARTICLE: ICD-10-CM Coding for Obstetrics
New coding concepts for Obstetrics include more specific codes to identify the trimester for complications of pregnancy, the weeks of gestation, and provides a 7th character option to identify a fetus when the care of the mother is altered during the pregnancy. Chapter 15 for pregnancy, childbirth, and the puerperium are reported with codes O00 through O9A.
New concepts for code selection include trimesters in most categories. Trimesters are identified as:
- 1st Trimester – less than 14 weeks, 0 days
- 2nd Trimester – 14 weeks 0 days to less than 28 weeks 0 days
- 3rd Trimester – 28 weeks, 0 days to delivery
In this example, the code selection offers choices for first, second, and third trimesters.
O11.1 Pre-existing hypertension with pre-eclampsia, first trimester
O11.2 Pre-existing hypertension with pre-eclampsia, second trimester
O11.3 Pre-existing hypertension with pre-eclampsia, third trimester
If the trimester is not included for a condition it is because the condition occurs in a specific trimester. For example, gestational diabetes does not include designations for trimesters as it usually occurs in the second or third trimester.
Instructional note at the beginning of Chapter 15 states to use an additional code from Category Z3A to report weeks of gestation. The alphabetic look-up for the weeks of gestation is Pregnancy, weeks of. The weeks of gestation correlate with the 4th and 5th character of the code, such as 16 weeks gestation would be reported as Z3A.16. (The code for less than 8 weeks gestation and more than 42 weeks gestation does not follow this pattern).
One other major change in ICD-10-CM is the use of a 7th character to identify the fetus affected by a condition that changed or alters the care provided to the mother. When it is not possible to determine the fetus affected or the pregnancy is for a single gestation, the seventh character of 0 (zero) is used for the 7th character. The 7th character extension is required for code categories O31, O32, O33.3 to O33.7, O35, O36, O40, O41, O60.1 to O60.2, O64, and O69.
Patient presents for 32 week monochorionic –diamniotic twin pregnancy. Fetus 1 is observed on ultrasound to be small for gestational age. Bi-weekly ante-natal testing is ordered.
O30.033 Twin pregnancy, monochorionic-diamniotic, third trimester
O36.5931 Pregnancy complicated by fetus, light for dates, third trimester – fetus 1
Z3A.32 32 weeks gestation of pregnancy
The guidelines for deliveries remain the same as in ICD-9. A normal vaginal delivery of a single gestation is reported with O80. The note states a delivery, requiring minimal or no assistance, with or without episiotomy, without fetal manipulation(rotation version) or instrumentation (forceps) of a spontaneous, cephalic, vaginal, full term, single, liveborn infant. This code is for use as a single diagnosis code and is not to be used with any other code from Chapter 15.
O82 is used for an encounter for cesarean delivery without indication.
Both O80 and O82 state to use an additional code to indicate outcome of delivery (Z37.0). This indicates that this is the only other code that can be reported with O80 and O82.
Twin Pregnancy coding is challenging and can be tricky. In ICD-10-CM the code selection is based on the number of gestations as well as the number of gestational sacs and the number of placenta (e) for the pregnancy.
Documentation for multiple gestations must include:
- Number of gestations
- Number of amniotic sacs and number of placentae
- 7th character is required to identify the fetus for which the complication affects.
23-year-old G3P2002 presents for ultrasound with Monochorionic /Diamniotic twins. Gestational age is 36 weeks 1 day. No complaints, no fluid leaking, labor precautions given, and fetal kick counts explained.
O30.033 Twin pregnancy, monochorionic /diamniotic third trimester
Z3A.36 36 weeks gestation of pregnancy
Documentation supports a monochorionic (one placenta) and diamniotic (2 amniotic sacs) twin gestation at 36 weeks.
Working with your physicians to insure documentation will support the specificity of the ICD-10-CM code set may not be as difficult as anticipated. Documentation for Obstetrics typically contains the necessary information to determine the gestational age, whether stated directly or determined by documentation of LMP or EDD.