- Additional codes from
other chapters may be used.
- These set of codes
should be used only on the maternal record.
- Don’t use these
codes for a newborn record.
Trimester
Most of the codes have a final
character indicating the trimester of pregnancy.
(1) First trimester
(up to 14 weeks)
(2) Second trimester (14 weeks 1 day to 28 weeks)
(3) Third trimester
(28 weeks 1 day to till delivery)
It is based on the physician’s
documentation or the number of the weeks of gestations. Z3A.- should
be used along with "O" series codes to indicate the
appropriate weeks of gestation, if the weeks of gestation is not known to use
unspecified codes Z3A.00
- Certain codes have characters
for only certain trimesters due to condition does not occur all the trimesters.
- When the document lacks
in providing details about the trimester – use Unspecified trimester.
7th Character for Fetus identification
To identify the
fetus for which the complication code applies
- Assign 7th character “0” For
single gestations (or) Insufficient documentation to determine the fetus
affected.
-
- 7th Characters 1 to 9 is for multiple
gestations to identify the affected fetus.
Category Z34 (Encounter for supervision of normal pregnancy) – Assign
only when there is no complications and just a routine OB visits.
- This code should not be
used with any codes from chapter 15 (Complications).
Category O09 (Supervision of high-risk pregnancy) – Assign when there are any
high-risk pregnancy OB visits. Should be used as primary Dx
- Chapter 15 codes
maybe used with this code.
Chapter 15 (Complication codes) – All the
complications which are treated or monitored should be assigned during the
antepartum visits.
Category Z37 (Outcome of delivery) – Use only on the delivery date on the
maternal record.
Pre-existing Hypertension in pregnancy – Category O10,
When assigning
codes from category O10, additional codes from hypertension category to specify
the type of heart failure or chronic kidney disease.
Pre-existing Diabetes mellitus in pregnancy
When assigning
codes from category O24, additional codes from category (E08-E13) for diabetes.
Gestational diabetes (Pregnancy induced)
- Can occur during
the 2nd or 3rd trimester, Use subcategory O24.4
- Don’t use
long-term use of insulin (Z79.4) with subcategory O24.4
Fetal conditions affecting the management of the mother
-
Codes O35 - O36 assigned only when the fetal
conditions are complicating pregnancy.
Any surgery performed to the fetus is still to be coded as
an OB encounter.
Category O35 (Maternal care for
known/suspected fetal abnormality and damage) should be assigned.
HIV infection in pregnancy
Use category
O98.7 as the primary Dx followed by other chapter codes.
Sepsis and septic shock complicating abortion, pregnancy,
childbirth and the puerperium
- Chapter 15
code should be the primary Dx.
- A code for
the specific type of infections should be assigned as additional Dx.
- If severe
sepsis is present code from subcategory R65.2 and codes for associated organ
dysfunction should also be used as additional Dx.
Alcohol and Tobacco use during pregnancy, childbirth and the
puerperium
Codes from subcategory O99.31 (Alcohol
use) should be assigned as primary Dx, followed by a code from category F10 to
identify the manifestations of alcohol use.
Codes from subcategory O99.33 (Tobacco
use) should be assigned as primary Dx, followed by a code from category F17 or
Z72.0 to identify the type of tobacco.
Poisoning, toxic effects, adverse effects and under-dosing in a
pregnant patient
A code from subcategory O9A.2 (Injury,
poisoning) should be sequenced first, followed by code from Poisoning, toxic
effects, adverse effects and under-dosing table.
Normal Delivery
-
Code O80 should be used for
normal delivery of a single healthy infant without any complications during
antepartum/delivery/postpartum.
No code from chapter 15 should be used
with O80
Use O80, if the patient had a complication and is not present at the time of delivery.
Use Z37.0 is the only outcome of
delivery code appropriate with O80
Cesarean Delivery – Assign the reason for the cesarean delivery as primary Dx.
Postpartum periods: Period begins after delivery and continues for six
weeks following delivery.
Peripartum periods: Period starts from last month of pregnancy to five months
postpartum.
Code Z39.0 (Encounter for care and examination of the mother
immediately after delivery) should be used when the mother delivers outside the
hospital prior to admission.
Cardiomyopathy associated with pregnancy:
Code O90.3, Cardiomyopathy
maybe developed in the third trimester but may continue after delivery.
Sequelae of complication of pregnancy, childbirth, and the
puerperium
Code O94, when an initial
complication of pregnancy develops sequelae requiring care or treatment at a
future date.
This is a
late effect code sequenced following the code describing the sequelae of the
complication.
Spontaneous Abortions / Termination of pregnancy
1) Abortion with a liveborn fetus:
An attempted termination of pregnancy results in a liveborn fetus, Assign code Z33.2 (Encounter for elective termination of pregnancy)and a code from category Z37 (Outcome of delivery)
2) Retained products of conception following an abortion:
For RPC following a spontaneous abortion or elective termination of pregnancy – Assign appropriate code from category O03 (spontaneous abortion) or O07.4 (Failed attempted termination of pregnancy without complication) and Z33.2 (Encounter for elective termination of pregnancy)
Abuse in a pregnant patient:
A code from subcategories
O9A.3 (Physical abuse complicating pregnancy)
O9A.4 (Sexual abuse
complicating pregnancy)
O9A.5 (Psychological abuse
complicating pregnancy)
Should be
sequenced first followed by any associated injury due to abuse.
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