June 5, 2012

Exploring ICD-10-CM’s Chapter 15: Pregnancy, Childbirth & the Puerperium

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In a previous article titled ICD-10: the Axis of Classification, we had indicated that one method for preparing your key stakeholders for the transition to ICD-10 was to break ICD-10-CM down into its basic components: chapters and axes of classification.

This article will continue that theme in reviewing changes we will encounter in ICD-10-CM’s Chapter 15, “Pregnancy, Childbirth & the Puerperium.” This chapter replaces Chapter 11 in ICD-9-CM, titled “Complications of Pregnancy, Childbirth & the Puerperium.” Codes from this chapter are for use only on maternal records, never on newborn records.

In the 2012 fiscal-year version of ICD-9-CM, the code range for Chapter 15 is 630-679 and consists of 1,104 codes. Compare this to 2012 version of ICD-10-CM, in which Chapter 15’s code range is O00-O99 and consists of 2,155 codes. This comparison nets us 1,051 additional codes, or an increase of 95 percent.

The ICD-10-CM version of Chapter 15 contains 3 percent of the total volume of available codes, and ranking it fourth in terms of chapters with the greatest number of total codes. Having identified the volume of codes within this chapter, you likely are wondering, why the significant increase? The answer to that can be explained by reviewing both the general and specific changes that have occurred in this chapter. We start by noting that there are nine subchapters in ICD-10-CM’s Chapter 15.

Chapter 15 Chapter Blocks

O00-O08    Pregnancy with abortive outcome

O09            Supervision of high-risk pregnancy

O10-O16    Edema, 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-O77    Complications of labor and delivery

O80, O82   Encounter for delivery

O85-O92    Complications predominantly related to the puerperium

O94-O9A   Other obstetric conditions, not elsewhere classified

 


 

In general, the changes you will note when reviewing Chapter 15 are:

 

  • Trimester of pregnancy now replaces the episode of care (antepartum, postpartum or delivery) as a secondary axis of classification for this chapter.
  • The trimester identifies the trimester of pregnancy in which the condition occurred, and is based on the trimester for the current admission.
  • Trimester is not an option for certain conditions due to irrelevancy. In addition, not all conditions or complications tend to occur across all three trimesters, and as a result, some conditions do not include the option for all three trimesters.
  • Trimester is captured by the final character for most codes in this chapter, when appropriate.
  • Trimesters are counted from the first day of the last menstrual period and are defined as follows:
    • First trimester: less than 14 weeks and 0 days
    • Second trimester: 14 weeks, 0 days to less than 28 weeks, 0 days
    • Third trimester: 28 weeks, 0 days until delivery occurs
  • Coding instructions also require use of an additional code from category Z3A to report weeks of gestation and to identify the specific week of pregnancy.
  • An additional code for the outcome of delivery (Z37.0-Z37.9) also is to be reported on the mother’s record.
  • Pre-existing conditions vs. conditions that are a direct result of pregnancy must be specified in the record.
  • Some codes require a seventh digit to identify the specific fetus (in multiple gestations) affected by the condition being coded. The seventh-character options are as follows:
  • Seventh character “0” is assigned if the particular condition being coded is not linked to a specific fetus in a multiple gestation, or is not applicable because this is a single gestation.
  • Seventh character “1” is assigned if the fetus identified as “Fetus 1” has the particular condition being coded.
  • Seventh character “2” is assigned if the fetus identified as “Fetus 2” has the particular condition being coded.
  • Seventh character “3” is assigned if the fetus identified as “Fetus 3” has the particular condition being coded.
  • Seventh character “4” is assigned if the fetus identified as “Fetus 4” has the particular condition being coded.
  • Seventh character “5” is assigned if the fetus identified as “Fetus 5” has the particular condition being coded.
  • Seventh character “9” is assigned if the fetus identified as “other fetus” has the particular condition being coded (for pregnancies with more than five fetuses when the condition occurs in a fetus numbered as “6”, “7,” etc.).
  • Many category title changes occur in this chapter (i.e. “early or threatened labor” vs. “false labor”).
  • New areas of high-risk pregnancy are included and located in Chapter 15, not in the V codes chapter as in ICD-9-CM.

In exploring chapter 15 in greater detail you will note the following:

  • Elective abortion codes are located in Chapter 21 (Factors Influencing Health Status and Contact with Health Services) in ICD-10-CM.
  • Pregnancy with hypertension is further classified as edema, gestational or pre-existing, then also by manifestation and trimester.
  • Pregnancy with diabetes is classified as pre-existing by type or gestational, along with how the diabetes is being treated in pregnancy (diet, insulin, unspecified, etc.), with trimester also denoted. Manifestations are coded separately.
  • Early vs. late vomiting in hyperemesis gravidarum is defined as occurring before the end of the 20th week (it was 22 completed weeks in ICD-9-CM).
  • An infection of the genitourinary tract in pregnancy is further specified by site (kidney, bladder, urethra, cervix, salpingo-oophoritis, other and unspecified) and trimester.
  • Many new codes have been added to indicate other complications of pregnancy, so be sure to review the alphabetical index to familiarize yourself with the new options.

These are just some of the examples of changes one can anticipate when using ICD-10-CM to report diseases of the musculoskeletal system and connective tissue.

About the Author

Angela Carmichael, MBA, RHIA, CCS, CCS-P, is director of HIM compliance for J.A. Thomas & Associates. Angela earned a Bachelor of Science degree, in Health Services Administration from Barry University and a MBA from Nova Southeastern University. She is a Registered Health Information Administrator and also has achieved the designations of Certified Coding Specialist, and Certified Coding Specialist-Physician and AHIMA Approved ICD-10-CM/PCS Instructor.

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Angela Carmichael