Chapter 15: Pregnancy, Childbirth and the
puerperium (O00-O9A)
General Rules for OB cases:
1) Codes from Chapter 15 and sequencing priority
O00 – O9A category codes should be assigned as primary Dx for OB cases.
- Additional codes from other chapters may be used.
2) Chapter 15 codes used only on the maternal record
- These set of codes should be used only on the maternal record.
- Don’t use these codes for a newborn record.
3) Final character for 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 week 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.
4) Selection of trimester for inpatient admissions that encompass
more than one trimester
5) Unspecified trimester
- When the document lacks in providing details about the trimester – use
Unspecified trimester.
6) 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.
b. Selection of OB principal or first-listed diagnosis
1) Routine outpatient prenatal visits
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).
2) Supervision of high-risk pregnancy
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.
3) Episodes when no delivery occurs
In episodes when no delivery occurs, the principal diagnosis should
correspond to the principal complication of the pregnancy which
necessitated the encounter. Should more than one complication exist,
all of which are treated or monitored, any of the complications codes
may be sequenced first.
4) When a delivery occurs
When an obstetric patient is admitted and delivers during that
admission, the condition that prompted the admission should be
sequenced as the principal diagnosis. If multiple conditions
prompted the admission, sequence the one most related to the
delivery as the principal diagnosis. A code for any complication of
the delivery should be assigned as an additional diagnosis.
5) Outcome of delivery
Category Z37 (Outcome of delivery) – Use only on the delivery date on the
maternal record.
c. Pre-existing conditions versus conditions due to the pregnancy
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
e. Fetal conditions affecting the management of the mother
1) Codes from categories O35 and O36
Codes O35 - O36 assigned only when the fetal conditions are complicating
pregnancy.
2) In utero surgery
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.
f. HIV infection in pregnancy, childbirth and the puerperium
Use category O98.7 as the primary Dx followed by other chapter codes.
g. Diabetes mellitus in pregnancy
Diabetes mellitus is a significant complicating factor in pregnancy.
Pregnant women who are diabetic should be assigned a code from category
O24, Diabetes mellitus in pregnancy, childbirth, and the puerperium, first,
followed by the appropriate diabetes code(s) (E08-E13) from Chapter 4
h. Long term use of insulin and oral hypoglycemics
Code Z79.4, Long-term (current) use of insulin, or code Z79.84, Long-term
(current) use of oral hypoglycemic drugs, should also be assigned if the
diabetes mellitus is being treated with insulin or oral medications. If the
patient is treated with both oral medications and insulin, only the code for
insulin-controlled should be assigned.
i. Gestational (pregnancy induced) diabetes
Gestational (pregnancy induced) diabetes can occur during the second and
third trimester of pregnancy in women who were not diabetic prior to
pregnancy. Gestational diabetes can cause complications in the pregnancy
similar to those of pre-existing diabetes mellitus. It also puts the woman at
greater risk of developing diabetes after the pregnancy. Codes for
gestational diabetes are in subcategory O24.4, Gestational diabetes
mellitus.
j. 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.
k. Puerperal sepsis Code O85,
Puerperal sepsis should be assigned with a secondary code to identify the
causal organism (e.g., for a bacterial infection, assign a code from category
B95-B96, Bacterial infections in conditions classified elsewhere). A code
from category A40, Streptococcal sepsis, or A41, Other sepsis, should not be
used for puerperal sepsis. If applicable, use additional codes to identify
severe sepsis (R65.2-) and any associated acute organ dysfunction.
l. Alcohol and tobacco use during pregnancy, childbirth and the
puerperium
1) Alcohol 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.
2) Tobacco use during pregnancy, childbirth and the puerperium
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.
m. Poisoning, toxic effects, adverse effects and underdosing 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.
n. Normal delivery, code O80
1) Encounter for full term uncomplicated 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
3) Uncomplicated delivery with resolved antepartum complication
Cesarean Delivery – Assign the reason for the cesarean delivery as
primary Dx.
4) Outcome of delivery for O80
Z37.0, Single live birth is the only outcome of delivery code appropriate for
use with O80.
o. The peripartum and postpartum periods
1) Peripartum and postpartum periods
Period begins after delivery and continues for six weeks following delivery.
2) Peripartum and postpartum complication
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.
3) Pregnancy-related complications after 6 week
period
Cardiomyopathy associated with pregnancy:
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.
4 .Admission for routine postpartum care following
delivery outside hospital
When the mother delivers outside the hospital prior to admission and
is admitted for routine postpartum care and no complications are
noted, code Z39.0, Encounter for care and examination of mother
immediately after delivery, should be assigned as the principal
diagnosis.
5) Pregnancy associated cardiomyopathy
Spontaneous Abortions / Termination of pregnancy
Code O90.3, Cardiomyopathy maybe developed in the third trimester but may
continue after delivery.
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.