17 Sept 2016

Chapter 15: Pregnancy, Childbirth and the puerperium (O00-O9A)

General Rules for OB cases:

         O00 – O9A category codes should be assigned as primary Dx for OB cases.


                 -  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.




        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 periodsPeriod 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



Test your Knowledge:

                    A. Chapter 15 Quiz