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ICD-10-CM Coding Guidelines - Pregnancy, Childbirth, and the Puerperium (Chapter 15) and Certain Conditions Originating in the Perinatal Period (Chapter 16)
 
 

ICD-10-CM Coding Guidelines - Pregnancy, Childbirth, and the Puerperium (Chapter 15) and Certain Conditions Originating in the Perinatal Period (Chapter 16)


Pregnancy, Childbirth, and the Puerperium (Chapter 15)

Chapter 15 of ICD-10-CM is titled "Pregnancy, Childbirth, and the Puerperium," which includes categories O00-O99. The first trimester of pregnancy is from day 0 through week 13. The second trimester spans from week 14 to week 27. The trimester spans from week 28 until delivery. When coding in this category, there are numerous aspects to be considered, such as high-risk pregnancy, various maternal conditions related to the delivery and puerperium, and abortive outcomes.

  • O00-O08 Pregnancy with Abortive Outcome – Codes in this subsection correspond with those in categories 630-639 of ICD-9-CM. Conditions coded include miscarriage, spontaneous abortion, missed abortion, tubal pregnancy, ectopic pregnancy, and other complications and conditions with an abortive outcome.

  • O09 Supervision of High-Risk Pregnancy - Codes in this subsection correspond with those in category V23 of ICD-9-CM. The condition of high-risk pregnancy can occur with a history of infertility, ectopic pregnancy, poor reproductive health, pre-term labor, grand muliparity, young primigravida, and more.

  1. O10-O16 Edema, Proteinuria, and Hypertensive Disorders in Pregnancy, Childbirth, and the Puerperium - Codes in this subsection correspond with those in categories 642, and 646 of ICD-9-CM. Conditions coded include hypertension, hypertensive heart disease, and hypertensive chronic kidney disease.

  • O20-O29 Other Maternal Disorders Predominantly Related to Pregnancy - Codes in this subsection correspond with those in categories 640, 643, 646, and 671 of ICD-9-CM. Conditions coded include excessive vomiting, threatened abortion, hemorrhage in pregnancy, varicose veins of lower extremity, genital varices, thrombophlebitis, hemorrhoids, cerebral venous thrombosis, genitourinary tract infections, pre-existing diabetes mellitus, gestational diabetes, malnutrition, weight gain or loss, and other related disorders.

  • O30-O48 Maternal Care Related to the Fetus and Amniotic Cavity and Possible Delivery Problems - Codes in this subsection correspond with those in categories 645 and 651-659 of ICD-9-CM. Conditions of this category include malpresentation of the fetus, intrauterine death, placental disorders, and more.

  • O60-O77 Complications of Labor and Delivery - Codes in this subsection correspond with those in categories 660-669 of ICD-9-CM. Conditions coded include long labor, failed induction of labor, preterm labor, and more.

  • O80-O82 Encounter for Delivery - Codes in this subsection correspond with those in categories 650 ad 669 of ICD-9-CM. Conditions coded include full-term uncomplicated delivery, which is used to report an unremarkable birth with or without episiotomy, and for cesarean delivery without indication.

  • O85-O92 Complications Predominantly Related to the Puerperium - Codes in this subsection correspond with those in categories 670-677 of ICD-9-CM. Conditions coded include puerperal sepsis, pyrexia, hemorrhoids, varicose veins, and more.

  • O94-O9A Other Obstetric Conditions, NEC - Codes in this subsection correspond with those in categories 647-649 of ICD-9-CM. Conditions coded include maternal infectious and parasitic diseases, late effects of obstetric conditions, abuse, anemia, and more.

General Guidelines

  •  ICD-10-CM does not require the use of a fifth digit to identify if an encounter is for delivery, antepartum, or postpartum, but it does classify most conditions according to trimester, using the final character to designate the trimester.

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  •  If the reason for care is not obstetric or related to the management of the pregnancy, the coder should assign a secondary code of Z33.1, Pregnant state, incidental.

  • When an admission to the hospital results in a delivery, the coder should assign a secondary code from category Z37, Outcome of delivery.

  •  With routine prenatal visits with the absence of complications, the coder should assign the first-listed code from category Z34, Encounter for supervision of normal pregnancy.

  •  If the pregnant female has a pre-existing hypertensive condition, the coder should assign a secondary code from the appropriate category to specify the type of heart failure, hypertension, or kidney disease.

  • Gestational diabetes is reported using codes in subcategory O24.4, Gestational Diabetes mellitus.

Certain Conditions Originating in the Perinatal Period (Chapter 16)

The perinatal period begins before birth and ends 28 days following the delivery. Perinatal conditions can occur from fetal development, chronic progressive infection, or an intrinsic anatomic abnormality. Chapter 16 of ICD-10-CM is titled "Certain Conditions Originating in the Perinatal Period," which includes code categories P00-P96.

  • P00-P04 Newborn Affected by Maternal Factors and by Complications of Pregnancy, Labor, and Delivery - Codes in this subsection correspond with those in categories 760-763 of ICD-9-CM. Conditions coded include all of those where the newborn is affected by maternal health disorders.

  • P05-P08 Disorders of Newborn Related to Length of Gestation and Fetal Growth - Codes in this subsection correspond with those in categories 764-766 of ICD-9-CM. Conditions coded include small for gestational age, extremely low birth weight, heavy for gestational age, post-term newborn, preterm newborn, and prolonged gestation of newborn.

  • P09 Abnormal Findings on Neonatal Screening - Codes in this subsection correspond with those in category 796 of ICD-9-CM. There is only one code in this subsection, 796.6, so when reporting code P09, the coder should assign secondary codes to report signs, symptoms, and other conditions associated with the screening.

  • P10-P15 Birth Trauma - Codes in this subsection correspond with those in category 767 of ICD-9-CM. Conditions coded include birth injuries casing intracranial laceration and hemorrhage, as well as disorders of the CNS, scalp, peripheral nervous system, succedaneum, skeleton, and other organs.

  • P19-P29 Respiratory and Cardiovascular Disorders Specific to the Perinatal Period - Codes in this subsection correspond with those in categories 768-770 of ICD-9-CM. Conditions coded include respiratory distress syndrome of newborn, hyaline membrane disease, wet lung syndrome, and more.

  • P35-P39 Infections Specific to the Perinatal Period - Codes in this subsection correspond with those in category 771 of ICD-9-CM. Conditions coded include congenital sepsis, parasitic diseases, omphalitis, and more. 

  • P50-P61 Hemorrhagic and Hematological Disorders Specific to the Perinatal Period - Codes in this subsection correspond with those in categories 772-776 of ICD-9-CM. Conditions coded include hemolytic diseases of newborn, jaundice due to hemolysis, kernicterus, and more. 

  • P70-P74 Transitory Endocrine and Metabolic Disorders Specific to Newborn - Codes in this subsection correspond with those in category 775 of ICD-9-CM. Conditions coded include iatrogenic neonatal hypoglycemia, neonatal diabetes mellitus, metabolic disorders, and more. 

  • P76-P78 Digestive System Disorders of Newborn - Codes in this subsection correspond with those in category 777 of ICD-9-CM. Conditions coded include obstruction due to inspissated milk, meconium ileus, meconium plug syndrome, and more. 

  • P80-P83 Conditions Involving the Integument and Temperature Regulation of Newborn - Codes in this subsection correspond with those in category 778 of ICD-9-CM. Conditions coded include environmental hyperthermia, fever, hydrops fetalis, neonatal erythema toxicum, and more. 

  • P84 Other Problems with Newborn - Codes in this subsection correspond with those in category 775 of ICD-9-CM. One code in this category covers academia, acidosis, anoxia, asphyxia, hypercapnia, hypoxemia, hypoxia, and mixed metabolic and respiratory acidosis. 

  • P90-P96 Other Disorders Originating in the Perinatal Period - Codes in this subsection correspond with those in category 779 of ICD-9-CM. Conditions coded include congenital hypertonia, congenital hypotonia, stillbirth, fetal death, and more. 

General Guidelines

  • The main diagnosis on the birth record for a newborn should be assigned a code form category Z38, Liveborn, according to place of birth and type of delivery. 

  • If a newborn, child, or adult patient has a history of being born prematurely or having low birth weight that affects the current status of health, the coder should use a secondary code from subcategory Z91.7, Low birth weight and immaturity status.

  • If a code from category P36 does not specify the causative organism, the coder should assign as secondary code from categories B95-B96 to identify the infectious agent.

 
 
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