Wiki Billing Delivery

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Code: O80

Code Name: ICD-10 Code for Encounter for full-term uncomplicated delivery

Block: Encounter for delivery (O80-O82)

Details: Encounter for full-term uncomplicated delivery
Delivery requiring minimal or no assistance, with or without episiotomy, without fetal manipulation [e.g., rotation version] or instrumentation [forceps] of a spontaneous, cephalic, vaginal, full-term, single, live-born infant. This code is for use as a single diagnosis code and is not to be used with any other code from Chapter 15 .

Use additional code to indicate outcome of delivery (Z37.0)

Guidelines: Pregnancy, childbirth and the puerperium (O00-O9A)

Note: CODES FROM THIS CHAPTER ARE FOR USE ONLY ON MATERNAL RECORDS, NEVER ON NEWBORN RECORDS
Codes from this chapter are for use for conditions related to or aggravated by the pregnancy, childbirth, or by the puerperium (maternal causes or obstetric causes)
Trimesters are counted from the first day of the last menstrual period. They are defined as follows:
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 until delivery


Use additional code from category Z3A, Weeks of gestation, to identify the specific week of the pregnancy

Excludes 1:supervision of normal pregnancy (Z34.-)

Excludes 2: mental and behavioral disorders associated with the puerperium (F53)
obstetrical tetanus (A34)
postpartum necrosis of pituitary gland (E23.0)
puerperal osteomalacia (M83.0)

For more details on O80, ICD-10 Code for Encounter for full-term uncomplicated delivery , visit: https://coder.aapc.com/icd-10-codes/

LKaf7

Networker
Messages
68
Location
Parma, OH
Best answers
0
Hello,

I work for a FQHC and we are recently receiving denials when we bill for our delivery charges from Caresource and UHC Community Plan. Normally we bill CPT 59409 with DX O80 (encounter for full-term uncomplicated delivery) and the outcome of the delivery, usually Z37.0 (Single live birth). The claims have always paid until recently and we are receiving a denial that the DX codes are inconsistent with the procedure. Am I missing something?

Thank you!
 

cjtown

Contributor
Messages
21
Location
Lexington, KY
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0
I found the following that may help:

ICD-10-CM Coding Rules
•O80 is applicable to maternity patients aged 12 - 55 years inclusive.
•O80 is applicable to female patients.
•O80 should be used on the maternal record - not on the newborn record.
Use a code under Z3A to document the exact week during the pregnancy OR

Reporting Birth Weight on Newborn Claims
Please note that providers are required to report newborn weight to UnitedHealthcare Community Plan. To report this data, the appropriate value code must be used:
UB-04: Report in block 39, 40 or 41 using value code “54” and the newborn’s weight grams. If billing electronically, please report birth weight in loop 2300, segment HI, with the qualifier BE and the value code “54” in HI01-2 and the newborn’s weight in grams in HI01-5.
UnitedHealthcare Community Plan references the following codes to identify newborn claims.
Therefore, please be sure to include birth weight on all claims containing these codes: ICD-10 Procedure Codes:ICD-10 Diagnosis Codes: 080 Normal Delivery. Z37.0 Outcome of Delivery

Hope this helps.
Carla:cool:
 
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