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Coding for Obstetrics inICD-10-CM/PCSAudio SeminarNovember 6, 2012Practical Tools for Seminar Learning Copyright 2012 American Health Information Management Association. All rights reserved.
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DisclaimerThe American Health Information Management Association makes norepresentation or guarantee with respect to the contents herein andspecifically disclaims any implied guarantee of suitability for any specificpurpose. AHIMA has no liability or responsibility to any person or entitywith respect to any loss or damage caused by the use of this audioseminar, including but not limited to any loss of revenue, interruption ofservice, loss of business, or indirect damages resulting from the use of thisprogram. AHIMA makes no guarantee that the use of this program willprevent differences of opinion or disputes with Medicare or other thirdparty payers as to the amount that will be paid to providers of service.CPT five digit codes, nomenclature, and other data are copyright 2012 bythe American Medical Association. All Rights Reserved. No fee schedules,basic units, relative values or related listings are included in CPT . The AMAassumes no liability for the data contained herein.As a provider of continuing education the American Health InformationManagement Association (AHIMA) must assure balance, independence,objectivity and scientific rigor in all of its endeavors. AHIMA is solelyresponsible for control of program objectives and content and the selectionof presenters. All speakers and planning committee members are expectedto disclose to the audience: (1) any significant financial interest or otherrelationships with the manufacturer(s) or provider(s) of any commercialproduct(s) or services(s) discussed in an educational presentation; (2) anysignificant financial interest or other relationship with any companiesproviding commercial support for the activity; and (3) if the presentationwill include discussion of investigational or unlabeled uses of a product.The intent of this requirement is not to prevent a speaker with commercialaffiliations from presenting, but rather to provide the participants withinformation from which they may make their own judgments.This material is designed and provided to communicate information aboutclinical documentation, coding, and compliance in an educational formatand manner. The author is not providing or offering legal advice but,rather, practical and useful information and tools to achieve compliantresults in the area of clinical documentation, data quality, and coding.Every reasonable effort has been taken to ensure that the educationalinformation provided is accurate and useful. Applying best practicesolutions and achieving results will vary in each hospital/facility and clinicalsituation.AHIMA 2012 Audio Seminar Series pxAmerican Health Information Management Association 233 N. Michigan Ave., 21 st Floor, Chicago, Illinoisii
DisclaimerDocument Usage RightsThis document is exclusively for use by individuals attending the associated audioseminar or webinar (named on the first page of this document), in conjunction withtheir attendance of the live or recorded version of the presentation. All materialherein is copyright 2012 American Health Information Management Association(AHIMA), except where otherwise noted. It may not be redistributed without priorwritten permission from AHIMA.iiiAHIMA 2012 Audio Seminar Series pxstAmerican Health Information Management Association 233 N. Michigan Ave., 21 Floor, Chicago, Illinois
FacultyAnn Barta, MSA, RHIA, is director of HIM Solutions for AHIMA. In her role, sheprovides professional expertise to AHIMA members, the media and outsideorganizations 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 largehealthcare system and has more than 30 years experience as a HIM Director andcoding consultant. She has been an educator of coding and HIM for more than 15years.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 contentdeveloper and external ICD-10-CM/PCS faculty for AHIMA. Previously, she wasmanager of Professional Practice Resources for AHIMA, providing professionalexpertise on coding practice issues. Ms. Zeisset has also been an educator of codingand HIM for over 25 years at multiple colleges, and served as adjunct faculty in theHIM Program at the University of Cincinnati.AHIMA 2012 Audio Seminar Series pxAmerican Health Information Management Association 233 N. Michigan Ave., 21 st Floor, Chicago, Illinois4
Table of ContentsAHIMA Audio Seminar/Webinar Terms of Use Agreement . iDisclaimer . iiDocument Usage Rights . iiFaculty . iiiObjectives . 1Organization of ICD-10-CM . 1ICD-10-CM Chapter 15 Sections . 2Terminology Change . 2Chapter Notes . 3Pregnancy with Abortive Outcomes . 3Supervision of High Risk Pregnancy . 4Supervision of Elderly Primigravida and Mulitgravida . 4Hypertension in Pregnancy, Childbirth and the Puerperium . 5Pre-Existing Essential Hypertension Complication Pregnancy . 5Infections of Genitourinary Tract in Pregnancy . 6Preterm Labor . 6-7Polling Question 1 . 7Chapter 15 Guidelines . 8Sequencing Priority . 8Chapter Codes Used on Maternal Record . 9Trimester . 9Documentation of Trimester . 10-117th Character for Fetus . 11Selection of OB Principal . 12-13Outcome of Delivery . 13-14Pre-Existing Conditions Versus Conditions due to the Pregnancy . 14-15Pre-Existing Hypertension in Pregnancy . 15Fetal Conditions Affection the Management of the Mother . 16-18Sepsis and Septic Shock . 18Alcohol Use . 19Tobacco Use . 19Poisoning, Toxic Effects, Adverse Effects and under dosing . 20Normal Delivery . 20The Peripartum and Postpartum Periods . 21Pregnancy Associated Cardiomyopathy. 22Code 094 . 22Termination of Pregnancy and Spontaneous Abortions . 23Case Study #1 . 24-25Case Study #2 . 25-26Codes and Guidelines ICD 10-PCS . 26Products of Conception-C1 . 27Procedures following Delivery or Abortion . 28Seven Characters . 28-30AHIMA 2012 Audio Seminar Series pxAmerican Health Information Management Association 233 N. Michigan Ave., 21 st Floor, Chicago, Illinois5
Table of ContentsIndex Terms . 31-32Extraction-Products of Conception . 33Polling Question 2 . 34Drainage-Root Operation . 34-35Audio Seminar Discussion – AHIMA Audio Seminar Community . 37Become an AHIMA Member Today! . 37Audio Seminars Information Online . 38Upcoming Audio Seminars . 38NEW – AHIMA Coder Workforce Training for ICD-10 . 39Thank You/Evaluation Form and CE Certificate (Web Address) . 39Appendix. 40Resource/Reference List . 41Mandatory Self-AssessmentCE Certificate InstructionsAHIMA 2012 Audio Seminar Series pxAmerican Health Information Management Association 233 N. Michigan Ave., 21 st Floor, Chicago, Illinois6
Coding for Obstetrics in lyze ICD-10-CM Chapter 15 categoriesExplain ICD-10-CM terminologyDiscuss organizational changesReview chapter 15 ICD-10-CM specific guidelinesDemonstrate coding examplesReviw ICD-10-PCS codes/guidelines1Chapter 15 Categories, Terminology and Organizational ChangesORGANIZATION OF ICD-10-CM2AHIMA 2012 Audio Seminar Series1
Coding for Obstetrics in ICD-10-CM/PCSNotes/Comments/QuestionsICD-10-CM Chapter 15 SectionsSectionSection TitleO00-O08Pregnancy with abortive outcomeO09Supervision of high-risk pregnancyO10-O16Edema, proteinuria and hypertensive disorders inpregnancy, childbirth, and the puerperiumO20-O29Other maternal disorders predominantly related topregnancyO30-O48Maternal care related to the fetus and amniotic cavityand possible delivery problemsO60-O77Complications of labor and deliveryO80, O82Encounter for deliveryO85-O92Complications predominately related to the puerperiumO94-O9AOther obstetric conditions, not elsewhere classified3Terminology Change Episode of care (delivered, antepartum,postpartum) is no longer the axis ofclassification In ICD-10-CM OB conditions are classified bythe trimester in which the condition occurred Trimesters are counted from the first day ofthe last menstrual period. They are definedas: 1st trimester – less than 14 weeks 0 days2nd trimester – 14 weeks 0 days to less than 28weeks 0 days3rd trimester – 28 weeks 0 days until delivery4AHIMA 2012 Audio Seminar Series2
Coding for Obstetrics in ICD-10-CM/PCSNotes/Comments/QuestionsChapter NotesCodes from this chapter are for use only onMaternal records, NEVER on Newborn recordsCodes from this chapter are for use forconditions related to or aggravated by thepregnancy, childbirth, or by the puerperium(maternal causes or obstetric causes)Use additional code from category Z3A, Weeksof gestation, to identify the specific week ofthe pregnancy5Pregnancy With AbortiveOutcomesICD-9-CM Ectopic and Molar Pregnancy(630-633)ICD-10-CM Pregnancy with abortiveoutcome (O00-O08) 630 Hydatidiform mole631 Other abnormal product ofconception632 Missed abortion 633 Ectopic pregnancy Other Pregnancy withAbortive Outcome (634-639) 634 Spontaneous abortion635 Legally induced abortion636 Illegally induced abortion637 Unspecified abortion638 Failed attempted abortion639 Complications followingabortion and ectopic/molarpregnancyAHIMA 2012 Audio Seminar Series O00 Ectopic pregnancyO01 Hydatidiform moleO02 Other abnormal productsof conceptionO03 Spontaneous abortionO04 Complications following(induced) termination ofpregnancyO07 Failed attemptedtermination of pregnancyO08 Complications followingectopic and molar pregnancy63
Coding for Obstetrics in ICD-10-CM/PCSNotes/Comments/QuestionsSupervision of High RiskPregnancyICD-9-CM V23 Supervision of highrisk pregnancy V23.0 Pregnancy with history ofinfertilityV23.1 Pregnancy with history oftrophoblastic diseaseV23.2 Pregnancy with history ofabortionV23.3 Grand multiparityV23.4 Pregnancy with other poorobstetric historyV23.7 Insufficient prenatal careV23.8 Other high-risk pregnancyV23.9 Unspecified high-riskpregnancyICD-10-CM Supervision of high riskpregnancy (O09) O09.0 with history of infertilityO09.1 with history of ectopic ormolar pregnancyO09.2 with other poorreproductive or obstetric historyO09.3 with insufficient antenatalcareO09.4 with grand multiparityO09.5 elderly primigravida andmultigravidaO09.6 young primigravida andmultigravidaO09.7 high risk pregnancy due tosocial problemsO09.8 other high risk pregnanciesO09.9 high risk pregnancy,unspecified7Supervision of ElderlyPrimigravida and MultigravidaICD-9-CM V23.81 ElderlyprimigravidaICD-10-CM O09.51 Supervision ofelderly primigravida V23.82 Elderlymultigravida O09.511 first trimesterO09.512 second trimesterO09.513 third trimesterO09.519 unspecifiedtrimester O09.52 Supervision ofelderly multigravida AHIMA 2012 Audio Seminar SeriesO09.521 first trimesterO09.522 second trimesterO09.523 third trimesterO09.529 unspecifiedtrimester84
Coding for Obstetrics in ICD-10-CM/PCSNotes/Comments/QuestionsHypertension in Pregnancy,Childbirth and the PuerperiumICD-9-CM 642 Hypertensioncomplicating pregnancy,childbirth, and the puerperium 642.0 Benign essentialhypertension642.1 Hypertension secondary torenal disease642.2 Other pre-existinghypertension642.3 Transient hypertension642.4 Mild or unspecified preeclampsia642.5 Severe pre-eclampsia642.6 Eclampsia642.7 Pre-eclampsia/eclampsiasuperimposed on pre-existinghypertension642.9 Unspecified hypertensionICD-10-CM Edema, proteinuria andhypertensive disorders inpregnancy, childbirth and thepuerperium (O10-O16) O10 Pre-existing essentialhypertensionO11 Pre-existing hypertensionwith pre-eclampsiaO12 Gestational edema andproteinuria without hypertensionO13 Gestational hypertensionwithout significant proteinuriaO14 Pre-eclampsiaO15 EclampsiaO16 Unspecified maternalhypertension9Pre-existing Essential HypertensionComplication Pregnancy O10.0 Pre-existing essential hypertension complicatingpregnancy, childbirth and the puerperium O10.01 Pre-existing essential hypertension complicatingpregnancy O10.011 Pre-existing essential hypertension complicatingpregnancy, first trimesterO10.012 Pre-existing essential hypertension complicatingpregnancy, second trimesterO10.013 Pre-existing essential hypertension complicatingpregnancy, third trimesterO10.019 Pre-existing essential hypertension complicatingpregnancy, unspecified trimesterO10.02 Pre-existing essential hypertension complicatingchildbirthO10.03 Pre-existing essential hypertension complicating thepuerperiumAHIMA 2012 Audio Seminar Series105
Coding for Obstetrics in ICD-10-CM/PCSNotes/Comments/QuestionsInfections of Genitourinary Tractin PregnancyICD-9-CM 646.6 Infection ofgenitourinary tract inpregnancy Additional code isassigned to identifysite of infection Additional code isassigned to identifyorganismICD-10-CM O23 Infections ofgenitourinary tract inpregnancy O23.0 Infections of kidney inpregnancyO23.1 Infections of bladder inpregnancyO23.2 Infections of urethra inpregnancyO23.3 Infections of other parts ofurinary tract in pregnancyO24.4 Unspecified infection ofurinary tract in pregnancyO23.5 Infections of the genitaltract in pregnancyO23.9 Unspecified genitourinarytract infection in pregnancy11Preterm LaborICD-9-CM 644 Early orthreatened labor644.0 Threatenedpremature labor 644.1 Other threatenedlabor 644.2 Early onset ofdelivery ICD-10-CM O60 Preterm LaborO60.0 Preterm laborwithout delivery O60.1 Preterm laborwith preterm delivery O60.2 Term deliverywith preterm labor 12AHIMA 2012 Audio Seminar Series6
Coding for Obstetrics in ICD-10-CM/PCSNotes/Comments/QuestionsO60.1 Preterm Labor with PretermDelivery O60.1 Preterm labor with preterm deliveryO60.10 Preterm labor with preterm delivery,unspecified trimester O60.12 Preterm labor second trimester withpreterm delivery second trimester O60.13 Preterm labor second trimester withpreterm delivery third trimester O60.14 Preterm labor third trimester withpreterm delivery third trimester 13Polling Question #1 What is the correct trimester for a patientthat is at 23 completed weeks ofgestation?1.First trimester2.Second trimester3.Third trimester4.Cannot determine – would need to querythe physician14AHIMA 2012 Audio Seminar Series7
Coding for Obstetrics in ICD-10-CM/PCSNotes/Comments/QuestionsICD-10-CM GuidelinesCHAPTER 15 GUIDELINES15Sequencing PriorityObstetric cases require codes from chapter 15Sequencing priority over other chaptersAdditional codes may be usedIncidental pregnancy Z33.1, Pregnant state, incidentalProvider’s responsibility to state that the condition beingtreated is NOT affecting pregnancyAHIMA 2012 Audio Seminar Series168
Coding for Obstetrics in ICD-10-CM/PCSNotes/Comments/QuestionsChapter 15 Codes Used onMaternal Record Chapter 15 codes are to beused only on the maternalrecord, never on the recordof the newborn Chapter 16: CertainConditions Originating inthe Perinatal Period (P00P96) never used onmaternal record17Trimester1st trimester less than 14 weeks 0 days2nd trimester 14 weeks 0 days to less than 28 weeks 0 days3rd trimester 28 weeks 0 days until deliveryAHIMA 2012 Audio Seminar Series189
Coding for Obstetrics in ICD-10-CM/PCSNotes/Comments/QuestionsDocumentation of Trimester Based on provider’s documentation Trimester, orNumber of weeks19More than One TrimesterMore than One TrimesterAdmitted to hospital during onetrimesterRemains in hospital into subsequenttrimesterTrimester when complicationdeveloped, not trimester of discharge20AHIMA 2012 Audio Seminar Series10
Coding for Obstetrics in ICD-10-CM/PCSNotes/Comments/QuestionsUnspecified Trimester Unspecified trimester should rarelybe used Documentation not sufficient and notpossible to obtain clarification217th Character for Fetus7th character to identify fetus number0 – not applicable or unspecified1 – fetus 14 – fetus 42 – fetus 25 – fetus 53 – fetus 39 – other fetusAHIMA 2012 Audio Seminar Series2211
Coding for Obstetrics in ICD-10-CM/PCSNotes/Comments/QuestionsSelection of OB Principal Routine outpatient prenatal visits Prenatal outpatient visits for high-riskpatients Code Z34, Encounter for supervision ofnormal pregnancyCategory O09, Supervision of high-riskpregnancyEpisodes when no delivery occurs Correspond to principal complication of23pregnancySelection of OB PrincipalWhen a deliveryoccursCesareandeliveryAdmitted withconditionresulting incesareanThat condition isprincipalCorrespond to maincircumstances orcomplication ofdeliveryConditionresponsible foradmissionUnrelated tocesarean – reason foradmission/encounteris principal24AHIMA 2012 Audio Seminar Series12
Coding for Obstetrics in ICD-10-CM/PCSNotes/Comments/QuestionsOutcome of Delivery Z37, Outcome of delivery included onevery maternal record delivered Examples on next slides2526AHIMA 2012 Audio Seminar Series13
Coding for Obstetrics in g Conditions VersusConditions due to the PregnancySome categories of Chapter 15 distinguishesbetween Conditions of mother that existed prior to pregnancy Those that are direct result of pregnancyAssess if condition was pre-existing or developedduring or due to pregnancyCategories that don’t distinguish – use for eitherUse codes for puerperium codes complicatingpregnancyAHIMA 2012 Audio Seminar Series2814
Coding for Obstetrics in g Hypertension inPregnancyO10.1 Pre-existinghypertensive heartdiseaseO10.2 Pre-existinghypertensivechronic kidneydiseaseO10.3 Pre-existinghypertensive heartand chronic kidneydiseaseUse additionalcode from I11to identify thetype ofhypertensiveheart diseaseUse additionalcode from I12to identify thetype ofhypertensivechronic kidneydiseaseUse additionalcode from I13to identify thetype ofhypertensiveheart andchronic kidneydisease30AHIMA 2012 Audio Seminar Series15
Coding for Obstetrics in ICD-10-CM/PCSNotes/Comments/QuestionsFetal Conditions Affecting theManagement of the Mother Codes from categories O35 and O36 O35, Maternal care for known orsuspected fetal abnormality and damageO36, Maternal care for other fetalproblemsAssigned when fetal condition modifiesmanagement of motherIn utero surgery Category O35Procedure code31HIV Infection in Pregnancy,Childbirth and the PuerperiumHIV-related illness Subcategory O98.7-, HIV complicatingpregnancy Code for HIM-related illness(es)Asymptomatic HIV infection status Subcategory O98.7-, HIV complicatingpregnancy Z21, Asymptomatic HIV infection status32AHIMA 2012 Audio Seminar Series16
Coding for Obstetrics in ICD-10-CM/PCSNotes/Comments/QuestionsDiabetes Mellitus in Pregnancy Diabetes mellitus Complicating factor in pregnancyO24, Diabetes mellitus inpregnancyAppropriate diabetes code(s)(E08-E13)Long term use of insulin Z79.4 also assigned if diabetesmellitus being treated with insulin33Gestational (Pregnancy Induced)Diabetes Occurs during second and thirdtrimester in women not previouslydiabetic causing complications Puts woman at greater risk ofdeveloping diabetes after pregnancy O24.4 Gestational diabetes mellitus Z79.4, Long-term use of insulin O99.81, Abnormal glucose34AHIMA 2012 Audio Seminar Series17
Coding for Obstetrics in ICD-10-CM/PCSNotes/Comments/QuestionsO24.435Sepsis and Septic ShockSepsisCode from chapter 15 specific type of infectionPuerperalsepsisO85, Puerperal sepsis causal organismNo code from categoryA40 or A41If severe sepsis present,R65.2-, Severe sepsis organ dysfunction code(s)If severe sepsis present,R65.2-, Severe sepsis organ dysfunction code(s)36AHIMA 2012 Audio Seminar Series18
Coding for Obstetrics in
American Health Information Management Association 233 N. Michigan Ave., 21st Floor, Chicago, Illinois 4 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 ICD-
