CHAPTER 15
PREGNANCY, CHILD BIRTH AND
PUERPERUIM (O00-09A)
Periods in pregnancy
Antepartum– Conceiving date to delivery.
Intrapartum– onset of labor , delivery of baby and lasts till the
delivery of placenta
Postpartum--- Time period from delivery upto 6 weeks (45 days)
following delivery.
Puerperium– The period after childbirth during which the mothers
reproductive organs return to their original non pregnant condition.
GENERAL RULES
O codes have sequencing priority over codes from
other chapters.
Whenever a condition in any other chapter (like E for
endocrine or I for circulatory) is complicating
pregnancy, the O code goes first, followed by the code
for the specific condition
Because Pregnancy affects everything else
During pregnancy, the patient’s body and treatment
priorities change — even for preexisting diseases
Z33.1
If pregnancy is incidental to the encounter , code Z33.1
When to use Z33.1
Encounter for a non-pregnancy-related issue and the
provider discovers the patient is pregnant-Incidental
finding:
During a visit for a sore throat, it is discovered that the
patient is pregnant.
Provider documentation: The provider must explicitly state
that the reason for the encounter is not affecting the
pregnancy for Z33.1 to be used in place of pregnancy-
related codes.
Example:
Pregnant woman comes for sore throat J02.9 + Z33.1
Pregnant woman comes for fractured arm
S42.309A + Z33.1
z34
Z34 codes are used when a pregnant woman is seen for routine,
uncomplicated prenatal visits —meaning no complications are
⚕️ ✅
present, and the pregnancy is progressing normally.
When to Use Z34
Use Z34 when:
The pregnancy is low-risk.
The visit is for routine supervision (e.g., prenatal checkup).
💡
No complications (no diabetes, hypertension, bleeding, etc.).
It is not used when complications exist — then you must use
the appropriate O code instead (e.g., O13.2 for gestational
hypertension).
O codes should be used only in maternal record.
These apply to pregnant, delivering, or postpartum women.
Use O Codes (O00–O9A)** — Only in maternity records
These apply to pregnant, delivering, or postpartum women.
🩺 **Examples:**
- O24.4 – Gestational diabetes mellitus
- O10.9 – Pre-existing hypertension complicating pregnancy
TRIMESTERS
For majority of codes final character indicate trimester of
pregnancy
O26.851 Spotting complicating pregnancy, first trimester
O26.852 Spotting complicating pregnancy, second trimester
O26.853 Spotting complicating pregnancy, third trimester
O99.011 Anemia complicating pregnancy, first trimester
TRIMESTERS
Trimesters are counted from the first day of the last menstrual
period.
First trimester – 0 to14 weeks (day 1 to 13 weeks and 6 days
Second trimester– 14 to 28 weeks ( 14 weeks to 27 weeks and 6
days)
Third trimester– 28 weeks until delivery
If the trimester is not documented, use 7th
character “9” (unspecified trimester) — but
only as a last resort.
Normal delivery term : 39 weeks, 0 days , through 40 weeks , 6
days , of gestation.
Z3A – WEEKS OF GESTATION
Z3A codes (Z3A.00–Z3A.49) are used to report the exact number of weeks of
⚕
gestation — that is, how far along the pregnancy is.
Purpose:
They provide additional detail for pregnancy-related encounters coded with O
codes
These codes help healthcare providers, researchers, and payers know the
progress of pregnancy at the time of visit or event.
Z3A
⚕ When to Use Z3A
✅ Use a Z3A code:
During all prenatal visits (to specify gestational age)
• With O codes (pregnancy complications)
• With Z34 codes (routine supervision)
❌
• At delivery (to show weeks of gestation at time of delivery)
Do NOT use Z3A:
• After delivery (postpartum encounters)
• When gestational age is not known or not applicable
If the stay of admission progress from one trimester to other trimester ,
code the trimester at the time of admission.
For e.g; Pt is admitted at 27 6/7 weeks gestation for
hemorrhaging from placenta previa, 2 days after admission
at 28 1/7 weeks gestation she developed gestational
hypertension.
Ans: O44.12 , O13.3 ,Z3A.27
Z34.90
Unspecified trimester should rarely be used (Z34.90), such as when
the documentation in the record is insufficient to determine the
trimester and it is not possible to obtain clarification.
7ᵗʰ character for fetus identification
O31,O32,O33.3-O33.6,O35,O36,O40,O41,O60.1,O60.2,O64 AND
O69
These codes describe situations where the mother is receiving
care because of a condition affecting the fetus or the delivery
process, even if the mother herself has no medical problem.
Assign 7ᵗʰ character 0: For single gestation
When the documentation in the record is insufficient to
determine the fetus affected and is not possible to obtain
clarification
When it is not possible to clinically determine which fetus is
affected
Example:
Maternal pt. with twin gestations Is seen after ultrasound
identifies fetus B to be in breech presentation
COMPLETED WEEKS OF GESTATION
This refers to full weeks.
Eg: if the provider documents , 39 weeks, 6 days;
Code for 39 weeks, not 40 weeks ( as the patient has not yet
reached 40 weeks)
O09– Supervision of high risk pregnancy
.Use only during prenatal period ( gestational period)
The O09 category is used when a woman is pregnant and under supervision because her
pregnancy is considered “high-risk.”
It’s used when no current complications are present, but the patient has conditions or
factors that put her at increased risk for complications.
💡 Key pointThese codes are for supervision (prenatal visits) — not for active
complications
If the pregnancy already has a complication (like gestational diabetes or pre-eclampsia),
then you use that specific O code (e.g., O24.4, O14.0) instead of O09.
Encounter for delivery and outcome of
delivery
O80
Encounter for full term uncomplicated delivery.
Meaning of “Uncomplicated”
✅
To qualify for O80:
All of these must be true:
1. Full-term pregnancy (usually 37–42 weeks)
2. Single fetus (not twins or multiples)
3. Spontaneous (no induction, no cesarean)
4. Vaginal delivery
5. No complications during labor, delivery, or postpartum
period
6. No other O-code applies for complications
OUTCOME OF DELIVERY Z37
When delivery occurs :
1ˢᵗ code: encounter reason (multiple condition exist code
the most related to delivery as principal diagnosis)
2ⁿᵈ code: any complication of delivery
3ʳᵈ code: weeks of gestation
4ᵗʰ code: outcome of delivery (Z37)
OUTCOME OF DELIVERY –Z37
FOR E.G; Maternal pt. with diet controlled gestational
diabetes was seen at 38 weeks gestation in obstructed
labor due to footling presentation , cesarean performed
for the malpresentation.
064.8XX0- Obstructed labor due to other malposition
and malpresentation , not applicable or unspecified.
O24.420– gestational diabetes mellitus in childbirth , diet
controlled
Z3A.38– 38 weeks of gestation of pregnancy
Z37.0 – single livebirth
Outcome of delivery
Z37- Used in maternal record , not in newborn record
Preexisting conditions v/s conditions due to
pregnancy (gestational)
For pre-existing conditions ,
1ˢᵗ code – O code
2ⁿᵈ code- pre existing
For gestational conditions,
Only O code
Pre existing hypertension in pregnancy– O10 category followed by
guidelines (I11/I12/I13)
Pregnancy induced hypertension (preeclampsia)- O13 ,O14 category
Preexisting DM in pregnancy – O24 CATEGORY FOLLOWED BY GUIDELINES
(E08/ E09/ E10/ E11/ E13)
Pregnancy induced ( gestational DM )– O24.4 Category
If a gestational diabetic patient is treated with both diet and insulin , code
only “insulin controlled”.
If a gestational diabetic pt is treated with diet and oral medications, then
code only “the controlled by oral hypoglycemic drug”)
Abnormal glucose tolerance in pregnancy – O99.81
HIV in pregnancy
Primary code – O98.7
Secondary code -- HIV guideline
For eg: A previously asymptomatic HIV pt. Who is 13 weeks gestation pregnant is evaluated for
HIV related candidial bronchitis
Ans: O98.711– HIV Complicating preg, cb , puerpuerium , 1ˢᵗ trimester
B20
B37.1– pulmonary candidiasis
Z3A.13 – 13 weeks of gestation pregnancy
Neoplasm in pregnancy
1 code – O9A.11
2 COD E; Neoplasm
Poisoning/toxic/adverse/underdosing
1 code : 09A.2
2 CODE: poisoning etc
3 code: condition
Puerperal sepsis
1 code ; 085
2ND CODE: Causative organism (B95-B96)
Alcohol use TOBACCO USE
1ˢᵗ code: O99.31 1ST CODE: O99.33
2ND CODE: F10 CAT 2ND CODE: F17 CAT
:
DRUG USE :
1ST CODE : O99.32
2ND COD E: F11-F16 cat F18-F19
The peripartum and postpartum periods
A postpartum complications – occurring within the six – week
period.
The peripartum period is defined as the last month of pregnancy to
5 months postpartum.
Pregnancy related complications after 6 weeks period – O cat codes
can be used
Z39.0
This is used when the mother is seen for routine postpartum care
immediately after giving birth —and no complications are present.
It’s for standard postpartum follow-up or hospital stay right after an
uncomplicated delivery.
PREGNANCY ASSOCIATED CARDIOMYOPATHY
(Heart muscle disease)
Code O90.3
Used when cardiomyopathy develops as a result of pregnancy in a
pt who did not have preexisting heart disease.
O94
O94 is used when a woman is being seen for a condition that originally occurred
during pregnancy, delivery, or the postpartum period —but the acute phase is
⚕️
over.
✅
When to Use O94 Use O94 when:
• The original pregnancy complication has ended,
• The patient is now being seen for a residual problem or after-effect,
💡 • The visit occurs after the postpartum period (beyond 6 weeks).
The O94 code identifies that her current problem is a sequela (result) of a
⚠️
previous obstetric condition.⸻
Do NOT use O94:
• For current or active pregnancy-related conditions.(Use the appropriate O00–
O9A code for current complications.)
• During the postpartum period (first 6 weeks) — still considered active
puerperium.
abortions
1. Abortion with live born fetus
1ˢᵗ code: z33.2– encounter for elective termination of pregnancy
2ⁿᵈ code: Z37 – outcome of delivery
2) Retained products of conception following an abortion
Subsequent encounter for RPC following a spontaneous abortion or ATP without
complications are assigned
O03.4 (Incomplete spontaneous abortion without complication)
O07.4 (Failed attempted termination of preg without complication).
If the pt. has a specific complication associated with the spontaneous abortion or elective
termination of pregnancy in addition to retained products of conception, assign the
appropriate complication code (O03;- , O04-;;, O07;-, ) Instead of codes O03.4,O07.4.
EXAMPLE:
Pt. was seen 2 days ago for complete spontaneous
abortion but returns today for UTI with ultrasound
showing retained products of conception
O03.38– UTI following incomplete spontaneous abortion
Hemorrhage following elective abortion
For hemorrhage post elective abortion , assign code O04.6
Do not assign code O72.1, other immediate postpartum
hemorrhage, as this code should not be assigned for post abortion
conditions.
Do not assign code Z33.2 when the pt experiences complication
post elective abortion.
Abuse in a pregnant patient
For suspected or confirmed cases of abuse of a pregnant pt
Physical abuse: O9A.3
Sexual abuse: 09A.4
Psychological abuse: O9A.5
Followed by the appropriate codes (if applicable) to identify any
associated current injury due to physical abuse , sexual abuse, and
perpetrator abuse.( who done the abuse)
COVID 19 INFECTION IN PREGNANCY
1. When COVID 19 is the reason for admission during pregnancy ,
childbirth or the puerperuim;
Primary code : O98.5 (other viral diseases complicating pregnancy ,
childbirth or the puerperuim)
Secondary code: UO7.1
Additional code = other associated manifestations
2. when the reason for encounter is unrelated to COVID 19 but the
pt tests positive for COVID 19 during the admission .
primary cod e: reason for admission
Secondary code: O98.5 (other viral disease complicating pregnancy,
childbirth, puerperuim)
3⁰ code : U07.1
Additional code: other associated manifestations
DIABETICS
Pre- existing type 2 diabetes mellitus , in pregnancy , childbirth and
the puerperium.
O24.1
O24.3
O24.8
O24.9
Under this codes Use additional –injectable non insulin ant diabetic
drugs (Z79.85 ) is added.
QUESTIONS
1. Pregnant pt at 21 week gestation admitted with excessive
vomiting. Find the code?
A) 021.8, Z3A.21
B) 021.2, Z3A.21
C) O21.2
D) R11.10, Z3A.21
2. Pt admitted at 27ᵗʰ week 6ᵗʰ day of gestation for
hemorrhaging from placenta previa, 3 days after admission at
28ᵗʰ week 1ˢᵗ day of admission , she developed gestational
hypertension . How will you code?
A) O44.12, Z3A.27 B) O44.12, O13.3, Z3A.27 C) O44.02,
O13.3, Z3A.27 D)O44.02,Z3A.27
3. Maternal pt. with twin gestational is seen after ultrasound identifies
fetus B to be in breech presentation. Find the code?
A) O32.1XX2 B)O33.1 C) O33.6XX2 D) O32.6XX2
4. At 39 weeks of gestation a maternal pt. present with antepartum
hemorrhage with coagulation defect , the next day the pt. goes into labor
and eventually delivers via cesarean section due to arrested active phase
of labor . Find the code ?
A) O62.1, O46.003, Z3A.39, Z37.0 B) O46.003, O62.1,Z3A.39, Z37.0
C)O46.8X3, O62.1, Z3A.39, Z37.0 D) O62.1, O46.8X3, Z3A.39, Z37.0
ANSWERS
1B
2B
3A
4B
What ICD-10-CM codes are reported on the maternal record for a
delivery of triplets that are all liveborn at 32 weeks of pregnancy?
Options:
a. O30.103, Z37.51, Z3A.32
b. Z37.9, Z3A.32
c. Z37.61, O30.102, Z3A.32
d. O30.109, Z37.9, Z3A.00
Answer and Explanation
✅ Correct Answer: a. O30.103, Z37.51, Z3A.32
Explanation: O30.103 = Triplet pregnancy, all liveborn; Z37.51 =
Triplets, all liveborn; Z3A.32 = 32 weeks gestation.
Question:A 32-year-old who is 21 weeks pregnant (antepartum)
presents with vaginal bleeding. She is admitted to the observation
unit to rule out a spontaneous [Link] ICD-10-CM code(s)
is/are reported?
Options:
a. O46.92, Z3A.21
b. O03.9
c. Z33.1
d. Z34.92, Z3A.21
Answer and Explanation
✅ Correct Answer: a. O46.92, Z3A.21
Explanation: O46.92 = Antepartum hemorrhage in the 2nd
trimester; Z3A.21 = 21 weeks gestation.
A pregnant woman in her 40th week has gestational diabetes which
is controlled by [Link] ICD-10-CM code(s) is/are reported?
Options:
a. O24.113, O24.410, Z3A.40
b. O24.410, O24.913
c. O24.913
d. O24.410, Z3A.40
Answer and Explanation
✅ Correct Answer: d. O24.410, Z3A.40
Explanation: O24.410 = Gestational diabetes controlled by diet;
Z3A.40 = 40 weeks gestation.
This 25-year-old patient was admitted with difficulty breathing. She
has AIDS and is 21 weeks pregnant. Workup reveals Pneumocystis
carinii [Link] is the correct diagnosis code(s)?
Options:
a. O98.712, B20, B59, Z3A.21
b. O98.312, B59
c. O98.719, B59, Z3A.21
d. B20, B59, Z3A.21
Answer and Explanation
✅ Correct Answer: a. O98.712, B20, B59, Z3A.21
Explanation: O98.712 = HIV complicating pregnancy, 2nd trimester;
B20 = AIDS; B59 = Pneumocystis pneumonia; Z3A.21 = 21 weeks
gestation.
A patient was admitted three weeks following a normal vaginal
delivery with a postpartum breast [Link] ICD-10-CM code is
reported?
Options:
a. O91.13
b. N61.1
c. O91.12
d. O91.22
Answer and Explanation
✅ Correct Answer: A. O91.13
Explanation: O91.22 =ABSCESS OF BREAST ASSOCIATED WITH THE
PUERPERIUM