# ICD-10 Coding/Pregnancy, Childbirth and the Puerperium

This lesson introduces ICD-10-CM Pregnancy, Childbirth and the Puerperium.

## Objectives and Skills

* Correctly apply ICD-10-CM coding guidelines for accurate selection and sequencing of diagnosis codes commonly used to describe complications of pregnancy, childbirth, and the puerperium
* Apply ICD-10-PCS coding guidelines for accurate selection of procedure codes commonly used to diagnose and treat complications of pregnancy, childbirth and the puerperium
* Explain what is included in a normal delivery and what excludes it from being a normal delivery
* Know and apply key terms from the chapter (i.e. gravida, para, antepartum, peripartum, postpartum, puerperium, etc)
* Demonstrate use of the proper Z codes when coding outcome of delivery

## Guidelines
### Part 1: Diagnoses

Chapter 15 Guidelines PowerPoint
Chapter 15 guidelines Introduction video

#### CG.I.C.15.a.1-6 (General Rules for Obstetrics Cases)

15.a.1 Chapter 15 codes and Sequencying Priority
15.a.2 and 15.a.3 Maternal record only and Final Character for Trimester
15.a.4 and 15.a.5 Selection of Trimester for Inpatient Admissions that Encompass More than One Trimester and Unspecified Trimester
15.a.6 Seventh Character for Fetus Identification

#### CG.I.C.15.b.1-5 (Selection of OB Principal or First-Listed Diagnosis)

15.b.1 Routine Outpatient Prenatal Visits
15.b.2 Supervision of High-Risk Pregnancy
15.b.3-5 Episode when No Delivery Occurs, When a Delivery Occurs, Outcome of Delivery

#### CG.I.C.15.c and d (Pre-existing Conditions vs Conditions Due to the Pregnancy and Pre-existing Hypertension in Pregnancy)

15.c and 15.d Pre-Existing Conditions vs Conditions Due to Pregnancy and Pre-Existing Hypertension in Pregnancy

#### CG.I.C.15.e.1-2 (Fetal Conditions Affecting the Management of the Mother)

15.e.1 and 15.e.2 Codes from Categories O35 and O36 and In Utero Surgery

#### CG.I.C.15.f (HIV Infection in Pregnancy, Childbirth and the Puerperium)

15.f HIV Infection in Pregnancy, Childbirth and the Puerperium

#### CG.I.C.15.g, h & i (Diabetes Mellitus in pregnancy, Long Term Use of Insulin and Oral Hypoglycemics and Gestational (Pregnancy Induced) Diabetes)

15.g, h, and i Diabetes Mellitus in Pregnancy, Long Term Use of Insulin and Oral Hypoglycemics and Gestational (Pregnancy-Induced) Diabetes

#### CG.I.C.15.j and k (Sepsis and septic shock complicating abortion, pregnancy, childbirth and the puerperium and Puerperal sepsis)

15.j and k Sepsis and Septic Shock Complicating Abortion, Pregnancy, Childbirth and the Puerperium and Puerperal Sepsis

#### CG.I.C.15.l and m (Alcohol, tobacco and drug use during pregnancy, childbirth and the puerperium and Poisoning, toxic effects, adverse effects and underdosing in a pregnant patient)

15.l and m . Alcohol, Tobacco and Drug Use During Pregnancy, Childbirth and the Puerperium Poisoning and Toxic Effects, Adverse Effects and Underdosing in a Pregnant Patient

#### CG.I.C.15.n.1-3 (Normal Delivery, Code O80)

15.n.1-3 Encounter for Full Term Uncomplicated Delivery, Uncomplicated Delivery with Resolved Antepartum Complication and Outcome of Delivery for O80

#### CG.I.C.15.o.1-5 (The Peripartum and Postpartum Periods)

15.o.1-3 Peripartum and Postpartum Periods, Peripartum and Postpartum Complication and Pregnancy-Related Complications after 6 Week Period
15.o.4 and 5 Admission for Routine Postpartum Care Following Delivery Outside Hospital and Pregnancy Associated Cardiomyopathy

#### CG.I.C.15.p.1-3 (Code O94, Sequelae of Complication of Pregnancy, Childbirth, and the Puerperium)

15.p.1-3 Code O94, After the initial postpartum period and Sequencing of Code O94

#### CG.I.C.15.q.1-3 (Termination of Pregnancy and Spontaneous Abortions)

15.q.1-3 Abortion with Liveborn Fetus, Retained Products of Conception following an abortion, and Complications leading to abortion

#### CG.I.C.15.r (Abuse in a pregnant patient)

15.r Abuse in Pregnant Patient
***Some examples can be found in your Coding Clinic here:
ICD-10-CM/PCS Coding Clinic®, Fourth Quarter 2016 Pages: 125-126 and 150
ICD-10-CM/PCS Coding Clinic®, First Quarter 2016 Pages: 3-6

### Part 2: Procedures

https://www.cms.gov/Medicare/Coding/ICD10/2019-ICD-10-PCS.html(Official 2019 PCS coding guidelines and Code Tables and Index)
ICD-10-PCS Procedure coding Obstetrics guidelines
PCS Obstetrics Guidelines video

#### Obstetric Procedure Case Examples

Procedure Examples 1 & 2
Procedure Examples 3 & 4
Procedure Examples 5 & 6
Procedure Example 7
Procedure Example Lacerations
Procedure Example Ectopic

## Learning Resources

ICD-10-CM Pregnancy and Childbirth Bootcamp
Demonstration of Stages of delivery
HTN in Pregnancy
Gestational Diabetes
Pre-existing diabetes and pregnancy

## Activities

Quizlets for Chapter 15 Guidelines:
https://quizlet.com/_68g0tq (Chapter 15 Guidelines - General rules for Obstetric Cases)
https://quizlet.com/_68gd67 (Chaapter 15 Guidelines - selection of OB Principle or First-listed Diagnosis)
https://quizlet.com/_68go3d (Chapter 15 Guidelines - pre-existing HTN, fetal conditions affecting mom, HIV, Diabetes)
https://quizlet.com/_68h1m4 (Chapter 15 Guidelines - sepsis, alcohol/tobacco, poisoning & normal delivery)
https://quizlet.com/_68hcgx (Chapter 15 Guidelines - Peripartum/Postpartum, Sequelae, termination/abortions)
Quizlets for Key Terms/Pregnancy Cheat Sheet:
https://quizlet.com/_68hzlm (Important Chapter 15 Key Terms)
https://quizlet.com/_68ia13 (Normal Delivery (O80) Notes & Important Z codes)

## Lesson Summary

Review:
Chapter 15 General Guideline Assessment
Chapter 15 Selection of OB principal and first listed diagnosis Assessment
Chapter 15 Pre-existing HTN & More Assessment
Chapter 15 Sepsis & More Assessment
Chapter 15 Peripartum & More Assessment
* Important Chapter 15 vocabulary (see Key Terms)
* Diagnosis Guidelines and Code Scenarios (see Guidelines and Coding Examples)
* Procedure Guidelines and Code Scenarios (see Guidelines and Coding Examples)

## Key Terms

Trimesters (majority of codes in Ch. 15 have a final character for trimester)
* First trimester – less than 14 weeks, 0 days
* Second trimester – 14 weeks, 0 days to less than 28 weeks, 0 days
* Third trimester – 28 weeks, 0 days to delivery
7th Character to Identify Fetus:
0 – single gestation, documentation on record is insufficient and unable to clarify or not clinically possible to determine which fetus)
1 – Fetus 1
2 – Fetus 2
3 – Fetus 3
4 – Fetus 4
5 – Fetus 5
9 – Other fetus
Peripartum and Postpartum Periods
Postpartum Period: Begins immediately after delivery and continues for 6 weeks
Peripartum Period: the last month of pregnancy to 5 months postpartum
Postpartum Complication: Any complication occurring within the 6 week window after delivery

##### ****Chapter 15 Important Terms Cheat Sheet********
## See Also

* ↑ hiacode (2019-01-31). "Coding Tip: Pregnancy, Childbirth, and the Puerperium Tidbits". HIAcode. Retrieved 2019-03-18.