Cesarean-Section Scar Coding in ICD-10

Cesarean-Section Scar Coding in ICD-10

When coding a previous or current cesarean-section (C-section) scar, Z98.891 History of uterine scar from previous surgery is appropriate when the mother is receiving antepartum care and has had a previous C-section delivery. You must confirm that the mother is receiving antepartum care that is considered routine, and there are (thus far) no complications with the pregnancy.

Code O34.21- Maternal care for scar from previous cesarean delivery is correct for postpartum care if the patient has had a C-section delivery. The sixth character indicates the type of scar. Encourage your providers to be exact and describe the scar with specificity:

O34.211 Maternal care for low transverse scar from previous cesarean delivery describes care for a low transverse scar

O34.212 Maternal care for classical scar from previous cesarean delivery describes care for a vertical scar – which is the classical scar from a C-section

These codes are to used only postpartum (not antepartum) because they infer that it is the scar that requires the care.

If the visit is a postpartum visit, the clinician should know which type of scar is present and should code accordingly. Even if the clinician did not perform the delivery, the medical record should reflect where the incision was made, and that information should be readily available to the clinician.

I recommend not reporting O34.21- with Z39.2 Encounter for routine postpartum follow-up, which describes routine postpartum follow up. If the patient has a scar that requires follow up, the visit generally would not be considered “routine.”

Code Z98.891 carries an exclusion (excludes 1) stating that maternal care due to uterine scar from a previous surgery should be billed with O34.2-. Code O34.2- indicates that the C-section scar requires care, rather than the actual pregnancy, leading some to believe that Z98.891 and O34.2- should not be billed together.  Some providers may argue that the scar from a previous C-section can complicate the current pregnancy, and therefore it is appropriate to use the codes together. If you bill this combination, watch closely how your payers respond.

Chelle Johnson

Chelle Johnson

Chelle Johnson, CPC, CPMA, CPCO, CPPM, CEMC, AAPC Fellow has over 25 years’ experience in the medical field. She has worked on both sides of the aisle, for insurance carriers as well as the facility and providers. She specializes in the following FQHC, Family Practice, Public Health, Compliance, Ob/Gyn, and Pediatrics. Her past 20 years has been with the County of Stanislaus Health Services Agency in Modesto, Calif.
Chelle Johnson

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Chelle Johnson, CPC, CPMA, CPCO, CPPM, CEMC, AAPC Fellow has over 25 years’ experience in the medical field. She has worked on both sides of the aisle, for insurance carriers as well as the facility and providers. She specializes in the following FQHC, Family Practice, Public Health, Compliance, Ob/Gyn, and Pediatrics. Her past 20 years has been with the County of Stanislaus Health Services Agency in Modesto, Calif.

2 Responses to “Cesarean-Section Scar Coding in ICD-10”

  1. vilde says:

    If I understand this correctly…O34.21_ should not be use as the principal diagnosis for the delivery if the mother has had a previous C-section??

  2. Patricia Brayton-Winter says:

    Actually, the AHA Coding Clinic for ICD-10-CM and ICD-10-PCS Fourth Quarter 2016 (page 51) listed guidance regard these specific codes: “Subsequent pregnancy and delivery management may be determined by the previous type of cesarean incision” indicating that this code can be used during the antepartum as well as delivery. They also stated of the code O34.29: “In addition, narrative has been added under code O34.29, Maternal care due to uterine scar from other previous surgery, to specifically identify patients who have a uterine scar from a previous myomectomy” which also indicates that this can be a complication of pregnancy not a postpartum follow-up care concern. Also, they went on to say, “A new history code of Z98.891, History of uterine scar from previous surgery, has been created to report a past history of other transmural uterine incision in patients who are not currently pregnant” which can be interpreted as Z98.891 cannot be used while the patient is pregnant leaving the only option of the O34.2- grouping and as stated above it seems is indicated for use during pregnancy and delivery. Plus there are codes for complications already in the puerperium section of the obstetrics chapter of ICD 10 such as O86.0 Infection of obstetric surgical wound or O90.0 Disruption of cesarean delivery wound. One last thought, the O34.2-, the provider is providing maternal care for the cesarean scar when he/she is calculating the patient’s TOLAC score or is taking the patient into surgery for a repeat cesarean. While I am aware of some payers are not wanting the O34.2- Maternal care for cesarean scar as a primary diagnosis on antepartum visits, I wonder if like educating our providers, sometimes we also need to educate our payers as well regarding ICD-10 guidances. (Note: Coding Clinic is the official publication for ICD-10-CM/PCS coding guidelines and advice as designated by the four cooperating parties, AHA, AHIMA, CMS, NCHS.)

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