Encounters for patients who are pregnant, in delivery, or in the puerperium, use codes from Chapter 15: Pregnancy, Childbirth and the Puerperium (O00-O9A). Inside, there are key data points and specific guidelines that must be followed at all times.
The first guideline is about sequencing priority. Chapter 15 codes have sequencing priority over codes from all other chapters. The only exception to this is if a pregnant woman is seen for an unrelated condition. In such cases, code Z33.1 Pregnant State, Incidental should be used after the primary reason for the visit.
The final character of the code indicates the trimester of pregnancy in most of the codes.
O34.91 - Maternal Care for Abnormality of Pelvic Organ, Unspecified, First Trimester
O34.92 - Maternal Care for Abnormality of Pelvic Organ, Unspecified, Second Trimester
O34.93 - Maternal Care for Abnormality of Pelvic Organ, Unspecified, Third Trimester
In cases where more than one fetus is present, a seventh character should be assigned to indicate the gestation and the fetus. The seventh character “0” is for single gestations and multiple gestations where the fetus is unspecified. Seventh characters “1” through “9” are for cases of multiple gestations to identify the fetus.
O31.00X0 - Papyraceous Fetus, Unspecified Trimester, Not Applicable or Unspecified
O31.00X1 - Papyraceous Fetus, Unspecified Trimester, Fetus 1
O31.00X2 - Papyraceous Fetus, Unspecified Trimester, Fetus 2
O31.00X5 - Papyraceous Fetus, Unspecified Trimester, Fetus 5
O31.00X9 - Papyraceous Fetus, Unspecified Trimester, Other Fetus
Pre-existing Conditions, Versus Conditions Due to Pregnancy
When assigning codes from Chapter 15, it should be evaluated whether or not a condition was pre-existing or developed during pregnancy.
Pre-Existing Hypertension in Pregnancy
Category O10 indicates pre-existing essential hypertension complicating pregnancy, childbirth and the puerperium. If the patient is suffering from hypertensive heart or chronic kidney disease, a secondary code from the appropriate hypertension category should be assigned.
HIV Infection in Pregnancy
If a patient is admitted due to a HIV-related illness during pregnancy, a code from category O98.7- Human Immunodeficiency Virus [HIV] disease complicating pregnancy, childbirth, and the puerperium should be listed as the principal diagnosis. A secondary code of HIV-related Illness should then be assigned.
Diabetes Mellitus in Pregnancy
Pregnant women who are diabetic prior to gestation should be assigned a code from category O24, Diabetes Mellitus in Pregnancy, Childbirth, and the Puerperium. A secondary code from the appropriate diabetes category (E08-E13) should be assigned.
Gestational diabetes is a type of diabetes that develops during pregnancy. Diabetes means your blood glucose, also called blood sugar, is too high. Too much glucose in your blood is not good for you or your baby.
Gestational diabetes is usually diagnosed in the 24th to 28th week of pregnancy. For Gestational Diabetes, you should assign code O24.4. Please not that no other code from category O24, Diabetes Mellitus in Pregnancy, Childbirth and Puerperium should be assigned along with O24.4.
Alcohol Use During Pregnancy
If a mother uses alcohol during pregnancy, a code from category O99.31 Alcohol use Complicating Pregnancy, Childbirth, and the Puerperium should be assigned followed by a code from category F10 Alcohol-related Disorders.
Tobacco Use During Pregnancy
If a mother uses any tobacco products during pregnancy, a code from category O99.33 Tobacco Use Complicating Pregnancy, Childbirth, and the Puerperium should be assigned followed by a code from category F17 Nicotine Dependence to identify type to Nicotine dependence.
Code O80 should be assigned for a full-term, normal delivery of a single, healthy infant without any complications during antepartum, delivery or postpartum. Code Z37.0 Single Live Birth should be assigned as a secondary code.
Spontaneous abortion and pregnancy loss is the natural death of an embryo or fetus before it is able to survive independently. Some use the cut-off of 20 weeks of gestation, after which fetal death is known as a stillbirth. If a spontaneous abortion is failed or incomplete, code O03.4 Incomplete Spontaneous Abortion Without Complication, or code O07.4 Failed Attempted Termination of Pregnancy Without Complication, should be assigned.
While coding for Pregnancy, Childbirth and Puerperium cases, it is important you follow the guidelines firmly. Properly assigning principal and secondary diagnoses as per appropriate guidelines and reviewing the entire note is the basis necessity.