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 with no abnormalities. You must confirm that the mother is receiving antepartum care and there are (thus far) no complications or abnormalities of the organs and soft tissues of the pelvis causing an obstruction or complication.

If the presence of a scar from a previous C-section is causing an obstruction or complication—such as requiring hospitalization, specific obstetric care, or cesarean delivery before the onset of labor—use O34.21- Maternal care for scar from previous cesarean delivery. This is also is correct code for postpartum care if the patient has had a C-section delivery.

Note that the sixth character in the above code indicates the type of scar. You should 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

O34.21- can be used for both the antepartum and postpartum care of the mother.

If the patient has a scar that is causing an obstruction or care beyond that is considered to be normal, the visit generally would not be considered “routine;” therefore, I recommend not coding O34.21- with Z34.- normal pregnancy.

Certified Plastic and Reconstructive Surgery Coder CPRC

If the care rendered is routine, and the C-section scar is not causing a complication or obstruction, the provider should report the history of a previous C-section scar with Z98.891 and the primary Z34.- diagnosis code.

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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