Coding for Obstetrics in
ICD-10-CM/PCS
Audio Seminar
November 6, 2012
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Faculty
Ann Barta, MSA, RHIA, is director of HIM Solutions for AHIMA. In her role, she
provides professional expertise to AHIMA members, the media and outside
organizations on professional practice issues. Ms. Barta is an AHIMA-approved ICD10-CM/PCS trainer, and serves as content developer and faculty for the AHIMA ICD-10CM/PCS Academies. Previously, she was a corporate coding manager for a large
healthcare system and has more than 30 years experience as a HIM Director and
coding consultant. She has been an educator of coding and HIM for more than 15
years.
Ann Zeisset, RHIT, CCS, CCS-P, is an independent consultant on ICD-10-CM/PCS.
Ms. Zeisset is an AHIMA-approved ICD-10-CM/PCS trainer, and serves as content
developer and external ICD-10-CM/PCS faculty for AHIMA. Previously, she was
manager of Professional Practice Resources for AHIMA, providing professional
expertise on coding practice issues. Ms. Zeisset has also been an educator of coding
and HIM for over 25 years at multiple colleges, and served as adjunct faculty in the
HIM Program at the University of Cincinnati.
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American Health Information Management Association • 233 N. Michigan Ave., 21 st Floor, Chicago, Illinois
4
Table of Contents
AHIMA Audio Seminar/Webinar Terms of Use Agreement ..................................................... i
Disclaimer ........................................................................................................................ ii
Document Usage Rights .................................................................................................... ii
Faculty .......................................................................................................................... iii
Objectives ........................................................................................................................ 1
Organization of ICD-10-CM ................................................................................................ 1
ICD-10-CM Chapter 15 Sections ......................................................................................... 2
Terminology Change ......................................................................................................... 2
Chapter Notes .................................................................................................................. 3
Pregnancy with Abortive Outcomes .................................................................................... 3
Supervision of High Risk Pregnancy ................................................................................... 4
Supervision of Elderly Primigravida and Mulitgravida ........................................................... 4
Hypertension in Pregnancy, Childbirth and the Puerperium .................................................. 5
Pre-Existing Essential Hypertension Complication Pregnancy ............................................... 5
Infections of Genitourinary Tract in Pregnancy ................................................................... 6
Preterm Labor ............................................................................................................... 6-7
Polling Question 1 ............................................................................................................. 7
Chapter 15 Guidelines ....................................................................................................... 8
Sequencing Priority ........................................................................................................... 8
Chapter Codes Used on Maternal Record ............................................................................ 9
Trimester ......................................................................................................................... 9
Documentation of Trimester ....................................................................................... 10-11
7th Character for Fetus .................................................................................................... 11
Selection of OB Principal ............................................................................................ 12-13
Outcome of Delivery .................................................................................................. 13-14
Pre-Existing Conditions Versus Conditions due to the Pregnancy ................................... 14-15
Pre-Existing Hypertension in Pregnancy ............................................................................ 15
Fetal Conditions Affection the Management of the Mother ............................................ 16-18
Sepsis and Septic Shock .................................................................................................. 18
Alcohol Use .................................................................................................................... 19
Tobacco Use ................................................................................................................... 19
Poisoning, Toxic Effects, Adverse Effects and under dosing ............................................... 20
Normal Delivery .............................................................................................................. 20
The Peripartum and Postpartum Periods .......................................................................... 21
Pregnancy Associated Cardiomyopathy............................................................................. 22
Code 094 ....................................................................................................................... 22
Termination of Pregnancy and Spontaneous Abortions ...................................................... 23
Case Study #1 ........................................................................................................... 24-25
Case Study #2 ........................................................................................................... 25-26
Codes and Guidelines ICD 10-PCS .................................................................................... 26
Products of Conception-C1 .............................................................................................. 27
Procedures following Delivery or Abortion ........................................................................ 28
Seven Characters ....................................................................................................... 28-30
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American Health Information Management Association • 233 N. Michigan Ave., 21 st Floor, Chicago, Illinois
5
Table of Contents
Index Terms .............................................................................................................. 31-32
Extraction-Products of Conception ................................................................................... 33
Polling Question 2 ........................................................................................................... 34
Drainage-Root Operation ............................................................................................ 34-35
Audio Seminar Discussion – AHIMA Audio Seminar Community .......................................... 37
Become an AHIMA Member Today! .................................................................................. 37
Audio Seminars Information Online .................................................................................. 38
Upcoming Audio Seminars ............................................................................................... 38
NEW – AHIMA Coder Workforce Training for ICD-10 ......................................................... 39
Thank You/Evaluation Form and CE Certificate (Web Address) .......................................... 39
Appendix
................................................................................................................... 40
Resource/Reference List ......................................................................................... 41
Mandatory Self-Assessment
CE Certificate Instructions
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6
Coding for Obstetrics in ICD-10-CM/PCS
Notes/Comments/Questions
Objectives
Analyze ICD-10-CM Chapter 15 categories
Explain ICD-10-CM terminology
Discuss organizational changes
Review chapter 15 ICD-10-CM specific guidelines
Demonstrate coding examples
Reviw ICD-10-PCS codes/guidelines
1
Chapter 15 Categories, Terminology and Organizational Changes
ORGANIZATION OF ICD-10-CM
2
AHIMA 2012 Audio Seminar Series
1
Coding for Obstetrics in ICD-10-CM/PCS
Notes/Comments/Questions
ICD-10-CM Chapter 15 Sections
Section
Section Title
O00-O08
Pregnancy with abortive outcome
O09
Supervision of high-risk pregnancy
O10-O16
Edema, proteinuria and hypertensive disorders in
pregnancy, childbirth, and the puerperium
O20-O29
Other maternal disorders predominantly related to
pregnancy
O30-O48
Maternal care related to the fetus and amniotic cavity
and possible delivery problems
O60-O77
Complications of labor and delivery
O80, O82
Encounter for delivery
O85-O92
Complications predominately related to the puerperium
O94-O9A
Other obstetric conditions, not elsewhere classified
3
Terminology Change

Episode of care (delivered, antepartum,
postpartum) is no longer the axis of
classification

In ICD-10-CM OB conditions are classified by
the trimester in which the condition occurred

Trimesters are counted from the first day of
the last menstrual period. They are defined
as:
•
•
•
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
4
AHIMA 2012 Audio Seminar Series
2
Coding for Obstetrics in ICD-10-CM/PCS
Notes/Comments/Questions
Chapter Notes
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)
Use additional code from category Z3A, Weeks
of gestation, to identify the specific week of
the pregnancy
5
Pregnancy With Abortive
Outcomes
ICD-9-CM
 Ectopic and Molar Pregnancy
(630-633)
ICD-10-CM
 Pregnancy with abortive
outcome (O00-O08)
•
•
630 Hydatidiform mole
631 Other abnormal product of
conception
632 Missed abortion
•
633 Ectopic pregnancy
•
•
•
 Other Pregnancy with
Abortive Outcome (634-639)
•
•
•
•
•
•
634 Spontaneous abortion
635 Legally induced abortion
636 Illegally induced abortion
637 Unspecified abortion
638 Failed attempted abortion
639 Complications following
abortion and ectopic/molar
pregnancy
AHIMA 2012 Audio Seminar Series
•
•
•
•
•
O00 Ectopic pregnancy
O01 Hydatidiform mole
O02 Other abnormal products
of conception
O03 Spontaneous abortion
O04 Complications following
(induced) termination of
pregnancy
O07 Failed attempted
termination of pregnancy
O08 Complications following
ectopic and molar pregnancy
6
3
Coding for Obstetrics in ICD-10-CM/PCS
Notes/Comments/Questions
Supervision of High Risk
Pregnancy
ICD-9-CM
 V23 Supervision of high
risk pregnancy
•
•
•
•
•
•
•
•
V23.0 Pregnancy with history of
infertility
V23.1 Pregnancy with history of
trophoblastic disease
V23.2 Pregnancy with history of
abortion
V23.3 Grand multiparity
V23.4 Pregnancy with other poor
obstetric history
V23.7 Insufficient prenatal care
V23.8 Other high-risk pregnancy
V23.9 Unspecified high-risk
pregnancy
ICD-10-CM
 Supervision of high risk
pregnancy (O09)
•
•
•
•
•
•
•
•
•
•
O09.0 with history of infertility
O09.1 with history of ectopic or
molar pregnancy
O09.2 with other poor
reproductive or obstetric history
O09.3 with insufficient antenatal
care
O09.4 with grand multiparity
O09.5 elderly primigravida and
multigravida
O09.6 young primigravida and
multigravida
O09.7 high risk pregnancy due to
social problems
O09.8 other high risk pregnancies
O09.9 high risk pregnancy,
unspecified
7
Supervision of Elderly
Primigravida and Multigravida
ICD-9-CM
 V23.81 Elderly
primigravida
ICD-10-CM
 O09.51 Supervision of
elderly primigravida
•
•
 V23.82 Elderly
multigravida
•
•
O09.511 first trimester
O09.512 second trimester
O09.513 third trimester
O09.519 unspecified
trimester
 O09.52 Supervision of
elderly multigravida
•
•
•
•
AHIMA 2012 Audio Seminar Series
O09.521 first trimester
O09.522 second trimester
O09.523 third trimester
O09.529 unspecified
trimester
8
4
Coding for Obstetrics in ICD-10-CM/PCS
Notes/Comments/Questions
Hypertension in Pregnancy,
Childbirth and the Puerperium
ICD-9-CM
 642 Hypertension
complicating pregnancy,
childbirth, and the puerperium
•
•
•
•
•
•
•
•
•
642.0 Benign essential
hypertension
642.1 Hypertension secondary to
renal disease
642.2 Other pre-existing
hypertension
642.3 Transient hypertension
642.4 Mild or unspecified preeclampsia
642.5 Severe pre-eclampsia
642.6 Eclampsia
642.7 Pre-eclampsia/eclampsia
superimposed on pre-existing
hypertension
642.9 Unspecified hypertension
ICD-10-CM

Edema, proteinuria and
hypertensive disorders in
pregnancy, childbirth and the
puerperium (O10-O16)
•
•
•
•
•
•
•
O10 Pre-existing essential
hypertension
O11 Pre-existing hypertension
with pre-eclampsia
O12 Gestational edema and
proteinuria without hypertension
O13 Gestational hypertension
without significant proteinuria
O14 Pre-eclampsia
O15 Eclampsia
O16 Unspecified maternal
hypertension
9
Pre-existing Essential Hypertension
Complication Pregnancy

O10.0 Pre-existing essential hypertension complicating
pregnancy, childbirth and the puerperium
•
O10.01 Pre-existing essential hypertension complicating
pregnancy
•
•
•
•
•
•
O10.011 Pre-existing essential hypertension complicating
pregnancy, first trimester
O10.012 Pre-existing essential hypertension complicating
pregnancy, second trimester
O10.013 Pre-existing essential hypertension complicating
pregnancy, third trimester
O10.019 Pre-existing essential hypertension complicating
pregnancy, unspecified trimester
O10.02 Pre-existing essential hypertension complicating
childbirth
O10.03 Pre-existing essential hypertension complicating the
puerperium
AHIMA 2012 Audio Seminar Series
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5
Coding for Obstetrics in ICD-10-CM/PCS
Notes/Comments/Questions
Infections of Genitourinary Tract
in Pregnancy
ICD-9-CM
 646.6 Infection of
genitourinary tract in
pregnancy
 Additional code is
assigned to identify
site of infection
 Additional code is
assigned to identify
organism
ICD-10-CM
 O23 Infections of
genitourinary tract in
pregnancy
•
•
•
•
•
•
•
O23.0 Infections of kidney in
pregnancy
O23.1 Infections of bladder in
pregnancy
O23.2 Infections of urethra in
pregnancy
O23.3 Infections of other parts of
urinary tract in pregnancy
O24.4 Unspecified infection of
urinary tract in pregnancy
O23.5 Infections of the genital
tract in pregnancy
O23.9 Unspecified genitourinary
tract infection in pregnancy
11
Preterm Labor
ICD-9-CM
 644 Early or
threatened labor
644.0 Threatened
premature labor
• 644.1 Other threatened
labor
• 644.2 Early onset of
delivery
•
ICD-10-CM
 O60 Preterm Labor
O60.0 Preterm labor
without delivery
• O60.1 Preterm labor
with preterm delivery
• O60.2 Term delivery
with preterm labor
•
12
AHIMA 2012 Audio Seminar Series
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Coding for Obstetrics in ICD-10-CM/PCS
Notes/Comments/Questions
O60.1 Preterm Labor with Preterm
Delivery

O60.1 Preterm labor with preterm delivery
O60.10 Preterm labor with preterm delivery,
unspecified trimester
• O60.12 Preterm labor second trimester with
preterm delivery second trimester
• O60.13 Preterm labor second trimester with
preterm delivery third trimester
• O60.14 Preterm labor third trimester with
preterm delivery third trimester
•
13
Polling Question #1

What is the correct trimester for a patient
that is at 23 completed weeks of
gestation?
1.
First trimester
2.
Second trimester
3.
Third trimester
4.
Cannot determine – would need to query
the physician
14
AHIMA 2012 Audio Seminar Series
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Coding for Obstetrics in ICD-10-CM/PCS
Notes/Comments/Questions
ICD-10-CM Guidelines
CHAPTER 15 GUIDELINES
15
Sequencing Priority
Obstetric cases require codes from chapter 15
Sequencing priority over other chapters
Additional codes may be used
Incidental pregnancy
• Z33.1, Pregnant state, incidental
Provider’s responsibility to state that the condition being
treated is NOT affecting pregnancy
AHIMA 2012 Audio Seminar Series
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8
Coding for Obstetrics in ICD-10-CM/PCS
Notes/Comments/Questions
Chapter 15 Codes Used on
Maternal Record

Chapter 15 codes are to be
used only on the maternal
record, never on the record
of the newborn

Chapter 16: Certain
Conditions Originating in
the Perinatal Period (P00P96) never used on
maternal record
17
Trimester
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
AHIMA 2012 Audio Seminar Series
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9
Coding for Obstetrics in ICD-10-CM/PCS
Notes/Comments/Questions
Documentation of Trimester

Based on provider’s documentation
•
•
Trimester, or
Number of weeks
19
More than One Trimester
More than One Trimester
Admitted to hospital during one
trimester
Remains in hospital into subsequent
trimester
Trimester when complication
developed, not trimester of discharge
20
AHIMA 2012 Audio Seminar Series
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Coding for Obstetrics in ICD-10-CM/PCS
Notes/Comments/Questions
Unspecified Trimester

Unspecified trimester should rarely
be used
•
Documentation not sufficient and not
possible to obtain clarification
21
7th Character for Fetus
7th character to identify fetus number
0 – not applicable or unspecified
1 – fetus 1
4 – fetus 4
2 – fetus 2
5 – fetus 5
3 – fetus 3
9 – other fetus
AHIMA 2012 Audio Seminar Series
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11
Coding for Obstetrics in ICD-10-CM/PCS
Notes/Comments/Questions
Selection of OB Principal

Routine outpatient prenatal visits
•

Prenatal outpatient visits for high-risk
patients
•

Code Z34, Encounter for supervision of
normal pregnancy
Category O09, Supervision of high-risk
pregnancy
Episodes when no delivery occurs
•
Correspond to principal complication of
23
pregnancy
Selection of OB Principal
When a delivery
occurs
Cesarean
delivery
Admitted with
condition
resulting in
cesarean
That condition is
principal
Correspond to main
circumstances or
complication of
delivery
Condition
responsible for
admission
Unrelated to
cesarean – reason for
admission/encounter
is principal
24
AHIMA 2012 Audio Seminar Series
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Coding for Obstetrics in ICD-10-CM/PCS
Notes/Comments/Questions
Outcome of Delivery

Z37, Outcome of delivery included on
every maternal record delivered

Examples on next slides
25
26
AHIMA 2012 Audio Seminar Series
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Coding for Obstetrics in ICD-10-CM/PCS
Notes/Comments/Questions
27
Pre-existing Conditions Versus
Conditions due to the Pregnancy
Some categories of Chapter 15 distinguishes
between
• Conditions of mother that existed prior to pregnancy
• Those that are direct result of pregnancy
Assess if condition was pre-existing or developed
during or due to pregnancy
Categories that don’t distinguish – use for either
Use codes for puerperium + codes complicating
pregnancy
AHIMA 2012 Audio Seminar Series
28
14
Coding for Obstetrics in ICD-10-CM/PCS
Notes/Comments/Questions
29
Pre-existing Hypertension in
Pregnancy
O10.1 Pre-existing
hypertensive heart
disease
O10.2 Pre-existing
hypertensive
chronic kidney
disease
O10.3 Pre-existing
hypertensive heart
and chronic kidney
disease
Use additional
code from I11
to identify the
type of
hypertensive
heart disease
Use additional
code from I12
to identify the
type of
hypertensive
chronic kidney
disease
Use additional
code from I13
to identify the
type of
hypertensive
heart and
chronic kidney
disease
30
AHIMA 2012 Audio Seminar Series
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Coding for Obstetrics in ICD-10-CM/PCS
Notes/Comments/Questions
Fetal Conditions Affecting the
Management of the Mother

Codes from categories O35 and O36
•
•
•

O35, Maternal care for known or
suspected fetal abnormality and damage
O36, Maternal care for other fetal
problems
Assigned when fetal condition modifies
management of mother
In utero surgery
•
•
Category O35
Procedure code
31
HIV Infection in Pregnancy,
Childbirth and the Puerperium
HIV-related illness
• Subcategory O98.7-, HIV complicating
pregnancy
• Code for HIM-related illness(es)
Asymptomatic HIV infection status
• Subcategory O98.7-, HIV complicating
pregnancy
• Z21, Asymptomatic HIV infection status
32
AHIMA 2012 Audio Seminar Series
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Coding for Obstetrics in ICD-10-CM/PCS
Notes/Comments/Questions
Diabetes Mellitus in Pregnancy

Diabetes mellitus
•
•
•

Complicating factor in pregnancy
O24, Diabetes mellitus in
pregnancy
Appropriate diabetes code(s)
(E08-E13)
Long term use of insulin
•
Z79.4 also assigned if diabetes
mellitus being treated with insulin
33
Gestational (Pregnancy Induced)
Diabetes

Occurs during second and third
trimester in women not previously
diabetic causing complications

Puts woman at greater risk of
developing diabetes after pregnancy

O24.4 Gestational diabetes mellitus

Z79.4, Long-term use of insulin

O99.81, Abnormal glucose
34
AHIMA 2012 Audio Seminar Series
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Coding for Obstetrics in ICD-10-CM/PCS
Notes/Comments/Questions
O24.4
35
Sepsis and Septic Shock
Sepsis
Code from chapter 15 +
specific type of infection
Puerperal
sepsis
O85, Puerperal sepsis +
causal organism
No code from category
A40 or A41
If severe sepsis present,
R65.2-, Severe sepsis +
organ dysfunction code(s)
If severe sepsis present,
R65.2-, Severe sepsis +
organ dysfunction code(s)
36
AHIMA 2012 Audio Seminar Series
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Coding for Obstetrics in ICD-10-CM/PCS
Notes/Comments/Questions
Alcohol Use

O99.31- Alcohol use
complicating pregnancy,
childbirth, and the
puerperium

F10-, Alcohol related
disorders also assigned for
manifestations of alcohol
use
37
Tobacco Use

O99.33- Smoking
(tobacco) complicating
pregnancy, childbirth, and
the puerperium

F17-, Nicotine dependence
also assigned for type of
dependence
38
AHIMA 2012 Audio Seminar Series
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Coding for Obstetrics in ICD-10-CM/PCS
Notes/Comments/Questions
Poisoning, Toxic Effects, Adverse
Effects and Underdosing

O9A.2, sequenced first, followed by injury,
poisoning, toxic effect, adverse effect or
underdosing code + condition caused
39
Normal Delivery, Code O80

Code O80
•
•
•
•
•
Full-term normal delivery of single,
healthy infant without any
complications antepartum, during
delivery, or postpartum
Always principal diagnosis
Not used with any other chapter 15 code
May be used if complication resolved
prior to admission for delivery
Z37.0, Single live birth
AHIMA 2012 Audio Seminar Series
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20
Coding for Obstetrics in ICD-10-CM/PCS
Notes/Comments/Questions
The Peripartum and Postpartum
Periods
Peripartum and postpartum periods
• Postpartum
• Immediately after delivery and continues for six weeks
• Peripartum
• Last month of pregnancy to five months postpartum
Peripartum and postpartum complication
• Any complication within six-week period
Pregnancy-related complications after 6 week
period
• Chapter 15 codes used if documentation indicates
41
Admission for Routine Postpartum
Care

Delivered outside hospital and admitted
with no complications
•
Z39.0, Encounter for care and examination
of mother immediately after delivery
42
AHIMA 2012 Audio Seminar Series
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Coding for Obstetrics in ICD-10-CM/PCS
Notes/Comments/Questions
Pregnancy Associated
Cardiomyopathy
 O90.3
• Cardiomyopathy
develops as result of
pregnancy
• Not pre-existing
heart disease
43
Code O94

Code O94, Sequelae of complication
of pregnancy, childbirth, and the
puerperium
•
•
•
Code O94 used for complication of
pregnancy developing a sequelae
Used at any time after the initial
postpartum period
Sequencing of Code O94
•
Sequenced following the code describing
the sequelae of the complication
AHIMA 2012 Audio Seminar Series
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22
Coding for Obstetrics in ICD-10-CM/PCS
Notes/Comments/Questions
Termination of Pregnancy and
Spontaneous Abortions
Abortion with Liveborn Fetus
• Z33.2, Encounter for elective termination of pregnancy +
Z37, Outcome of delivery
Retained Products of Conception following an
abortion
• O03, Spontaneous abortion, or O07.4, Failed attempted
termination of pregnancy + Z33.2, Encounter for elective
termination of pregnancy
Complications leading to abortion
• O07 and O08 + codes from Chapter 15
45
Abuse in a Pregnant Patient

O9A.3, Physical abuse

O9A.4, Sexual abuse

O9A.5, Psychological abuse
•
•
Sequenced first
Followed by codes to identify current
injury + perpetrator of abuse
46
AHIMA 2012 Audio Seminar Series
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Coding for Obstetrics in ICD-10-CM/PCS
Notes/Comments/Questions
Coding Examples
APPLICATION OF GUIDELINES
47
Case #1

The patient, G1P0, was admitted in active
labor at 38 completed weeks of gestation. The
patient was dilated to 6 cm approximately 7
hours following admission. Pitocin
augmentation was started and she progressed
to complete dilation. A second degree
perineal laceration occurred during delivery
and was repaired. The nuchal cord was
wrapped around the neck of the fetus without
compression. A female infant was delivered
with Apgar scores of 9 and 9. Code the
diagnoses only.
48
AHIMA 2012 Audio Seminar Series
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Coding for Obstetrics in ICD-10-CM/PCS
Notes/Comments/Questions
Case #1

O70.1
Second degree perineal
laceration during delivery

O69.81X0
Labor and delivery
complicated by cord around
neck, without compression

Z3A.38
38 weeks gestation of
pregnancy

Z37.0
Single live birth
49
Case #2

The patient is admitted in active labor
at 39 weeks gestation. The patient
has experienced no complications
during her pregnancy. The patient
labors for 9 hours and delivers a
liveborn male with Apgars of 9 and 9
over an intact perineum. Code the
diagnosis codes only.
50
AHIMA 2012 Audio Seminar Series
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Coding for Obstetrics in ICD-10-CM/PCS
Notes/Comments/Questions
Case #2

O80
Encounter for full-term
uncomplicated delivery

Z3A.39
39 weeks gestation of
pregnancy

Z37.0
Single live birth
51
Codes and Guidelines
ICD-10-PCS
52
AHIMA 2012 Audio Seminar Series
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Coding for Obstetrics in ICD-10-CM/PCS
Notes/Comments/Questions
Products of Conception – C1

Procedures performed on the products of
conception are coded to the Obstetrics
section. Procedures performed on the
pregnant female other than the products of
conception are coded to the appropriate
root operation in the Medical and Surgical
section.
•
Example: Amniocentesis is coded to the
products of conception body part in the
Obstetrics section. Repair of obstetric urethral
laceration is coded to the urethra body part in
the Medical and Surgical section.
53
Products of Conception

Refer to all components of pregnancy
•
•
•
•
•

Fetus
Embryo
Amnion
Umbilical cord
Placenta
No differentiation of the products of
conception based on gestational age
54
AHIMA 2012 Audio Seminar Series
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Coding for Obstetrics in ICD-10-CM/PCS
Notes/Comments/Questions
Procedures Following Delivery or
Abortion
Procedures performed following a delivery or
abortion for curettage of the endometrium or
evacuation of retained products of conception are
all coded in the Obstetrics section, to the root
operation Extraction and the body part Products
of Conception, Retained. Diagnostic or therapeutic
dilation and curettage performed during times
other than the postpartum or post-abortion period
are all coded in the Medical and Surgical section,
to the root operation Extraction and the body part
Endometrium.

55
Seven Characters
Obstetrics Section - 1
Character Character Character
1
2
3
Section
(1)
Body
System
Root
Operation
Character
Character
4
5
Body Part Approach
Character Character
6
7
Device
Qualifier
Mid Forceps
Low Cervical
Vacuum
Laminaria
56
AHIMA 2012 Audio Seminar Series
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Coding for Obstetrics in ICD-10-CM/PCS
Notes/Comments/Questions
Character Values

Character 2 (Body System)
•

One single body system, Pregnancy
Character 4 (Body Part) – three body
part values
•
•
•
Products of conception
Products of conception, retained
Products of conception, ectopic
57
Root Operations in Obstetrics Section
Obstetrics Section Root Operations
Abortion
Change
Delivery
Drainage
Extraction
Insertion
Inspection
Removal
Repair
Reposition
Resection
Transplantation
58
AHIMA 2012 Audio Seminar Series
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Coding for Obstetrics in ICD-10-CM/PCS
Notes/Comments/Questions
Abortion – Root Operation A
Abortion
A
Definition
Explanation
Examples
Artificially terminating a
pregnancy
Subdivided according to
whether an additional device
such as a laminaria or
abortifacient is used; or
whether the abortion was
performed by mechanical
means
Transvaginal abortion using
vacuum aspiration technique
59
Delivery – Root Operation E
Delivery
E
Definition
Assisting the passage of
the products of
conception from the
genital canal
Explanation
Applies only to manuallyassisted, vaginal delivery
Examples
Manually-assisted delivery
Delivery applies only to manually-assisted, vaginal delivery and is defined as
assisting the passage of products of conception from the genital canal.
Cesarean deliveries are coded in this section to the root operation Extraction.
60
AHIMA 2012 Audio Seminar Series
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Coding for Obstetrics in ICD-10-CM/PCS
Notes/Comments/Questions
Index Terms

Abortion
•
•
•
•
Abortifacient 10A07ZX
Laminaria 10A07ZW
Products of Conception 10A0
Vacuum 10A07Z6
61
Abortion – 10A
62
AHIMA 2012 Audio Seminar Series
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Coding for Obstetrics in ICD-10-CM/PCS
Notes/Comments/Questions
Index Terms

Delivery
•
•
•
•
•
Cesarean see Extraction, Products of
Conception 10D0
Forceps see Extraction, Products of
Conception 10D0
Manually assisted 10E0XZZ
Products of Conception 10E0XZZ
Vacuum assisted see Extraction,
Products of Conception 10D0
63
Delivery
64
AHIMA 2012 Audio Seminar Series
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Coding for Obstetrics in ICD-10-CM/PCS
Notes/Comments/Questions
Extraction – Products of Conception
65
Extraction
66
AHIMA 2012 Audio Seminar Series
33
Coding for Obstetrics in ICD-10-CM/PCS
Notes/Comments/Questions
Polling Question #2

What ICD-10-PCS code is assigned
for a low cervical Cesarean section?
1.
10D00Z0
2.
10D00Z1
3.
10D00Z2
4.
10E0XZZ
67
Drainage – Root Operation 9
Drainage
9
Definition
Explanation
Examples
Taking or letting out
fluids and/or gases from
a body part
The qualifier identifies the
substance that is drained
from the products of
conception (fetal blood, fetal
spinal fluid, amniotic fluid)
Amniocentesis, percutaneous
fetal spinal tap
68
AHIMA 2012 Audio Seminar Series
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Coding for Obstetrics in ICD-10-CM/PCS
Notes/Comments/Questions
Drainage
69
Insertion/Removal
70
AHIMA 2012 Audio Seminar Series
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Coding for Obstetrics in ICD-10-CM/PCS
Notes/Comments/Questions
Resource/Reference List

ICD-10-CM Coding System; ICD-10CM Guidelines. CDC. 2013.
http://www.cdc.gov/nchs/icd/icd10
cm.htm

ICD-10 Procedure Coding System
(ICD-10-PCS); ICD-10-PCS
Guidelines. CMS. 2013.
http://www.cms.gov/ICD10
71
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Coding for Obstetrics in ICD-10-CM/PCS
Notes/Comments/Questions
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Coding for Obstetrics in ICD-10-CM/PCS
Notes/Comments/Questions
Upcoming Audio Seminars
Coding for Injuries and
Poisoning in ICD-10 CM
November 8, 2012
2012 Coding Clinic Updates
November 15, 2012
CY13 CPT Updates
December 6, 2012
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Coding for Obstetrics in ICD-10-CM/PCS
Notes/Comments/Questions
ICD-10-CM/PCS Coding for
Obstetrics
Download your Resource Book at
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Audio Seminar
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AHIMA 2012 Audio Seminar Series
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Appendix
Resource/Reference List ......................................................................................... 29
Mandatory Self-Assessment
CE Certificate Instructions
AHIMA 2012 Audio Seminar Series
40
Appendix
Resource/Reference List
http://www.qualityindicators.ahrq.gov
http://www.ahrq.gov/qual/qitoolkit
http://www.gpo.gov/fdsys/pkg/FR-2012-05-11/pdf/2012-9985.pdf
http://www.cms.gov/Medicare/Medicare-Fee-for-ServicePayment/HospitalAcqCond/downloads/HACFactsheet.pdf
http://www.iqh.org/attachments/219_CoreMHelpBookletpg4_11_3.pdf
http://www.gpo.gov/fdsys/pkg/FR-2010-08-16/html/2010-19092.htm
http://library.ahima.org/xpedio/groups/public/documents/ahima/bok2_001166.hcsp?dDocName=bok2_00
1166 Level three
AHIMA 2012 Audio Seminar Series
41
ICD-10-CM/PCS Coding for Obstetrics
Mandatory Self-Assessment
Instructions: Select the best answer choice.
1. When a patient is admitted to the hospital for complications of a pregnancy
and the hospitalization overlaps more than one trimester, how is the
antepartum complication code for trimester assigned?
 The trimester of discharge
 Trimester when complication developed
 Unspecified trimester
 None of the above
2. What seventh character is assigned when a triplet birth identifies that fetus B
(2) has a nuchal cord? We are coding the nuchal cord condition.
 0
 1
 2
 3
3. What outcome of delivery code is assigned when quadruplets are born, 2
liveborn, 2 stillborn?
 Z37.62
 Z37.9
 Z37.52
 Z37.63
4. The patient is in her 26th week and develops hypertension. She has never
had hypertension before. What code is assigned?
 O10.012
 O16.2
 O10.013
 O16.3
5. Code O80 is only reported with ICD-10-PCS code 10E0XZZ.
 True
 False
-----------------------------------------------------------------------------------------------------------Do not send a copy of completed self-assessments to AHIMA. Please keep
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Page 1 of 2
ICD-10-CM/PCS Coding for Obstetrics
Mandatory Self-Assessment
6. The third trimester is defined as ________ weeks 0 days until delivery.
 14
 28
 37
 40
7. Amniocenteses would be coded to the Medical and Surgical Section of ICD10-PCS.
 True
 False
8. What code is assigned for a preterm labor that started at 25 weeks, was
stopped and the delivery occurred at 30 weeks?
 O60.10
 O60.12
 O60.13
 O60.14
9. Products of conception include:
 Fetus
 Umbilical cord
 Placenta
 All of the above
10. What root operation is assigned in ICD-10-PCS when a high forceps delivery
is performed?
 Delivery
 Removal
 Extraction
 Resection
-----------------------------------------------------------------------------------------------------------Do not send a copy of completed self-assessments to AHIMA. Please keep
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