Ob-Gyn Coding Alert

Question: There are different families of O codes for hemorrhage (we are comfortable using O26.85x1,2,3,9 Spotting complicating pregnancy). What is the subtle/fundamental difference between codes (our EHR - IMO does not differentiate between the two families very well)?

• O20.0 - Threatened abortion (includes hemorrhage before completion of 20 wks) hemorrhage specified as due to threatened abortion
• O20.8 Other hemorrhage in early pregnancy
• O20.9 Hemorrhage in early pregnancy, unspecified
• O46 Antepartum hemorrhage not elsewhere classified (with various subcategories & their particular indications for coagulation defects) but then follows
• O46.8x1,2,3,9 Other antepartum hemorrhage.

If these are not classified elsewhere and in early pregnancy, what is the difference?

Illinois Subscriber

Answer: The O20 code category is used only for any bleeding that occurs before the completion of 20 weeks gestation. Threatened abortion refers the presence of bleeding with a closed cervix and a fetal heat beat. Possible causes of bleeding during the first trimester include:

• Threatened abortion
• Implantation bleeding — which occurs about 10 to 14 days after conception
• Problems with the cervix, such as a cervical infection, inflamed cervix or growths on the cervix
• Ectopic pregnancy
• Molar pregnancy
• Bleeding following an accident (or spouse abuse)
• Fibroids or vaginal infection

Ectopic and molar pregnancies have their own codes so you would not use O20 if the cause of the bleeding was confirmed.

The O46 code category is used only for bleeding in the antepartum period after 20 completed weeks of gestation. Placenta previa and abruption are the most likely causes, but they have their own codes and so the O46 codes would not be reported. Two other causes would be due to coagulation disease in the mother or afibrinogenemia but an “other” code is provided to cover any other known reason. These “other” reasons can include in the 2nd and 3rd trimesters:

• intrauterine fetal death after 20 weeks
• Placental abruption/previa
• Cervicitis
• Incompetent cervix
• Problems with the cervix, such as a cervical infection, inflamed cervix or growths on the cervix
• Preterm labor— which might result in light bleeding — especially when accompanied by contractions, dull backache or pelvic pressure
• Uterine rupture or bleeding due to injury

Some of these conditions have their own codes, but if the source of bleeding has not been confirmed, the “other” code is appropriate to use.