Revenue Cycle Management in the Age of ICD-10: A Primer for OB-GYN

ICD 10 code for pregnancy and all things OB-GYNContinuing our series on ICD-10 basics we are offering high-level primers to illustrate the differences on specific documentation requirements for various specialties. We will also give some samples of how ICD-9-CM codes common for those specialties compare to ICD-10-CM codes. Again, much of the material in these specialty-specific blog posts is based on guidelines and material published by CMS in its Road to 10 Series. There is a lot of questionable information and advice out there and we want to help improve the consistency and reduce the uncertainty by going to the source of regulations. We will summarize and consolidate to enhance readability and brevity. The application of ICD-10 documentation requirements and the common codes for OB-GYN is the focus of this post. In ICD-10-CM, there are three main categories of changes:

  • Definition Changes
  • Terminology differences
  • Increased specificity

There is more than one ICD 10 code for pregnancy. In fact, there are twice as many obstetrical codes in ICD-10-CM (2,155) as in ICD-9 (1,104). These new codes add specificity to the characterization of obstetrical conditions. The ICD-10-CM obstetric codes are listed in Chapter 15. These codes have sequencing priority over those from other chapters and start with the letter “O,” (not the number zero). Unlike the ICD-9 codes, ICD-10-CM obstetrical codes are not divided by antepartum, delivery, and postpartum status, but most new codes indicate the trimester of pregnancy in their final character. An additional code from category Z3A should be used to define specific weeks of gestation (eg, Z3A.42 would indicate 42 weeks’ gestation). The Z codes connote reasons for encounters in the ICD-10 system.

Normal Pregnancy:

Codes for supervision of normal pregnancy (Z34.-) are used only for patients who have no conditions complicating maternal or obstetric care. Codes in category Z34 are subclassified as normal first pregnancy (Z34.0-), other normal pregnancy (Z34.1-), and normal pregnancy unspecified (Z34.9-). A fourth character is required to identify the trimester. Prenatal visit coding First, compare and contrast the code choices for a typical prenatal visit for a woman having a normal first pregnancy. In ICD-9-CM, you would report V22.0 (supervision of normal first pregnancy). ICD-10-CM gives you these four choices:

Z34.00 Encounter for supervision of normal first pregnancy, unspecified trimester
Z34.01 Encounter for supervision of normal first pregnancy, first trimester
Z34.02 Encounter for supervision of normal first pregnancy, second trimester
Z34.03 Encounter for supervision of normal first pregnancy, third trimester

The trimester is counted from the first day of the patient’s last menstrual period:

  • First trimester, less than 14 weeks 0 days
  • Second trimester, 14 weeks 0 days through less than 28 weeks 0 days
  • Third trimester, 28 weeks 0 days until delivery

When reporting circumstances for a patient, you need not only the trimester, but the specific week of gestation. Use additional code from category Z3A (weeks of gestation) to identify the specific week of the pregnancy. The code choices in the Z3A code category begin with:  

Z3A.01 Less than 8 weeks gestation of pregnancy
Z3A.08 8 weeks gestation of pregnancy
Z3A.09 9 weeks gestation of pregnancy
The codes increase one week at a time from there, all the way to:
Z3A.42 42 weeks gestation of pregnancy
Z3A.49 Greater than 42 weeks gestation of pregnancy

  Routine office visits during uncomplicated pregnancies require a code from category Z34 (“Encounter for supervision of normal pregnancy”) as the first diagnosis, but no codes from Chapter 15. When a patient has had a full-term uncomplicated delivery of a healthy singleton fetus following an uncomplicated pregnancy and postpartum course, code O80 is used and no others from chapter 15. This code should be accompanied by Z37.0 (Single live birth) as the only outcome-of-delivery code.

Complications of Pregnancy, Childbirth and the Puerperium:

For routine prenatal outpatient visits for patients with high-risk pregnancies, a code from category O09, Supervision of high-risk pregnancy, should be used as the first-listed diagnosis. Secondary chapter 15 codes may be used in conjunction with these codes if appropriate. Codes for reporting complications of pregnancy, childbirth, and the puerperium are in chapter 15 of ICD-10-CM and begin with the letter "O". Including the trimester in which the condition occurs, and seventh digits to identify the fetus affected, when necessary, are the main structural changes for classifying complication of pregnancy codes. The episode of care designations used in ICD-9-CM are no longer an axis of classification in ICD-10-CM. For complications of pregnancy, the trimester during which the complication occurs is part of the code selection in ICD-10-CM and the trimester should be documented. The number of weeks the patient is pregnant will determine the code selection. In ICD-10-CM, there is no longer the fifth digit classification for episode of care that is used in ICD-9-CM. The trimester is included as part of the complete code description. In Chapter 15, supervision of normal pregnancy is a type 1 excludes listed at the chapter level. This means that codes in category Z34 cannot be reported in conjunction with any code from Chapter 15. If pregnancy is incidental to the encounter, then code Z33.1, Pregnant state, incidental, should be used in place of any chapter 15 codes. It is the provider’s responsibility to state that the condition being treated is not affecting the pregnancy. The seventh character ‘0’ is for single gestations and multiple gestations where the fetus affected is unspecified. The seventh characters 1 to 9 are for cases of multiple gestations to identify the fetus for which the code applies. Further coding instructions may also require that a code from category O30 Multiple gestation be assigned when reporting a code with a seventh character. Chapter 15: O00–O99 – Pregnancy, childbirth and the puerperium

(O00–O08) Pregnancy with abortive outcome
(O10–O16) Oedema, 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–O75) Complications of labour and delivery
(O80–O84) Delivery
(O85–O92) Complications predominantly related to the puerperium
(O95–O99) Other obstetric conditions, not elsewhere classified

ICD-10 Code Examples:

O26.851 Spotting complicating pregnancy, first trimester
O26.852 Spotting complicating pregnancy, second trimester
O26.853 Spotting complicating pregnancy, third trimester
O26.859 Spotting complicating pregnancy, unspecified trimester
O99.011 Anemia complicating pregnancy, first trimester
O13.2 Gestational [pregnancy-induced] hypertension without significant proteinuria, second trimester
O24.012 Pre-existing diabetes mellitus, type 1, in pregnancy, second trimester

Normal Delivery: Code O80

Code O80 should be assigned when a woman is admitted for a full- term normal delivery and delivers a single, healthy infant without any complications antepartum, during the delivery, or postpartum during the delivery episode. Code O80 is always a principal diagnosis. It is not to be used if any other code from chapter 15 is needed to describe a current complication of the antenatal, delivery, or perinatal period. Additional codes from other chapters may be used with code O80 if they are not related to or are in any way complicating the pregnancy. Code O80 may be used if the patient had a complication at some point during the pregnancy, but the complication is not present at the time of the admission for delivery. A code from category Z37, Outcome of Delivery, should be included on every maternal record when a delivery has occurred. These codes are not to be used on subsequent records or on the newborn record. Z37.0, Single live birth, is the only outcome of delivery code appropriate for use with O80. Sample ICD-10-CM Codes for Complications of Labor and Delivery (060-077):

O65.5 Obstructed labor due to abnormality of maternal pelvic organs O66.3, Obstructed labor due to other abnormalities of fetus Use additional code to identify cause of obstruction
O66.41  Failed attempted vaginal birth after previous cesarean delivery (Code first rupture of uterus, if applicable (O71.0-, O71.1))
O70 Perineal laceration during delivery Includes: episiotomy extended by laceration 
O72.- Postpartum hemorrhage Includes: hemorrhage after delivery of fetus or infant Postpartum hemorrhage is defined as a blood loss in excess of 500 ml after delivery.
O72.0  Third-stage hemorrhage Hemorrhage associated with retained, trapped or adherent placenta Retained placenta NOS Code also type of adherent placenta (O43.2-)
O74  Complications of anesthesia during labor and delivery Includes: maternal complications arising from the administration of a general, regional or local anesthetic, analgesic or other sedation during labor and delivery Use additional code, if applicable, to identify specific complication
O75.3  Other infection during labor Sepsis during labor Use additional code (B95-B97), to identify infectious agent
O75.4  Other complications of obstetric surgery and procedures Cardiac arrest following obstetric surgery or procedures.Cardiac failure following obstetric surgery or procedures. Cerebral anoxia following obstetric surgery or procedures. Pulmonary edema following obstetric surgery or procedures Use additional code to identify specific complication

Comparison of ICD-9CM to ICD-10-CM Codes:

Supervision of Normal Pregnancy ICD-9-CM Codes

V22.0 Supervision of normal first pregnancy
V22.1 Supervision of other normal pregnancy
V22.2 Pregnant state, incidental

ICD-10-CM Codes

Z34.00* Encounter for supervision of normal first pregnancy, unspecified trimester
Z34.01 Encounter for supervision of normal first pregnancy, first trimester
Z34.02 Encounter for supervision of normal first pregnancy, second trimester
Z34.03 Encounter for supervision of normal first pregnancy, third trimester
Z34.80* Encounter for supervision of other normal pregnancy, unspecified trimester
Z34.81 Encounter for supervision of other normal pregnancy, first trimester
Z34.82 Encounter for supervision of other normal pregnancy, second trimester
Z34.83 Encounter for supervision of other normal pregnancy, third trimester
Z34.90* Encounter for supervision of normal pregnancy, unspecified, unspecified trimester
Z34.91* Encounter for supervision of normal pregnancy, unspecified, first trimester
Z34.92* Encounter for supervision of normal pregnancy, unspecified, second trimester
Z34.93* Encounter for supervision of normal pregnancy, unspecified, third trimester

*Codes with a greater degree of specificity should be considered first. Noninflammatory Disorders of the Ovary, Fallopian Tube and Broad Ligament ICD-9-CM

620.0 Noninflammatory disorders of ovary, fallopian tube and broad ligament
620.1 Corpus luteum cyst or hematoma
620.2 Other and unspecified ovarian cyst
620.3 Acquired atrophy of ovary and fallopian tube
620.4 Prolapse or hernia of ovary and fallopian tube
620.5 Torsion of ovary, ovarian pedicle or fallopian tube
620.6 Broad ligament laceration syndrome
620.7 Hematoma of broad ligament
620.8 Other noninflammatory disorders of ovary, fallopian tube and broad ligament
620.9 Unspecified noninflammatory disorder of ovary, fallopian tube and broad ligament

ICD-10-CM

N83.0 Follicular cyst of ovary
N83.1 Corpus luteum cyst
N83.20* Unspecified ovarian cysts
N83.29 Other ovarian cysts
N83.31 Acquired atrophy of ovary
N83.32 Acquired atrophy of fallopian tube
N83.33 Acquired atrophy of ovary and fallopian tube
N83.4 Prolapse and hernia of ovary and fallopian tube
N83.51 Torsion of ovary and ovarian pedicle
N83.52 Torsion of fallopian tube
N83.53 Torsion of ovary, ovarian pedicle and fallopian tube
N83.6 Hematosalpinx
N83.7 Hematoma of broad ligament
N83.8 Other noninflammatory disorders of ovary, fallopian tube and broad ligament
N83.9* Noninflammatory disorder of ovary, fallopian tube and broad ligament, unspecified

*Codes with a greater degree of specificity should be considered first.

Please bear in mind these are only the most common icd 10 codes for OB-GYN and pregnancy. Should you need more, please feel free to visit our comprehensive ICD-10 database.

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