With the transition to ICD-10 looming, we are going to see a variety of changes within the ICD-10-CM Official Guidelines for Coding and Reporting (PDF, 502 KB). One chapter to focus extra attention on will be Chapter 15: Pregnancy, Childbirth, and the Pueperium (O00-O9A). Below you will find some information that may be helpful to ease the transition.
With ICD-10-CM, the sequencing priority has not changed; as with ICD-9-CM, Chapter 15 codes have sequencing priority over codes from other chapters and it is still the “provider’s responsibility to state that the condition being treated is not affecting the pregnancy” and these Chapter 15 codes are only to be used on the maternal record.
Just as you are accustomed to with ICD-9-CM, where you have the fifth digit to indicate whether the encounter is antepartum, postpartum or whether a delivery has occurred, you will now have a final character to indicate the trimester of the pregnancy. The provider can document the trimester or they can simply document the specific number of weeks and days. Certain codes have characters for specific trimesters only because the condition may not occur in all trimesters or occur in more than just one. As you will see in the ICD-10-CM Coding Guidelines, the ‘unspecified trimester’ code “should rarely be used, such as when the documentation in the record is insufficient to determine the trimester and it is not possible to obtain clarification.” With many ICD-10-CM codes, it will be necessary to query the provider for clarification, at least until they become aware of the vast nuances that ICD-10-CM will bring.
Example: with ICD-9-CM, a patient presenting with a twin pregnancy would be coded as 651.0X with the fifth digit to denote the episode of care, along with the appropriate V code to indicate the outcome of delivery. Using the same scenario for ICD-10-CM, you will code O30.9X with the final character to denote the appropriate trimester. Your outcome of delivery code will come from Chapter 21 (Z37).
Aside from those codes where the trimester is ‘built in’ to the code selection, if a patient comes in with a pre-existing issue, a code from ICD-10-CM Chapter 21 category Z3A will be required on the maternal record to indicate the weeks of gestation. These codes are to be appended as additional codes to the Chapter 15 codes.
Example: a patient at 22 weeks 2 days presents with pre-existing HTN, you will choose code O10.012; as this code indicates the pre-existing HTN complicating the pregnancy of the second trimester.
Another area to focus additional attention on will be the selection of trimester for inpatient admission that encompass more than one trimester. In the event that a patient is admitted for complications of pregnancy during one semester but remains in the hospital into a subsequent trimester, “the trimester character for the antepartum complication code should be assigned on the bases of the trimester when the complication developed, not the trimester of the discharge”.
With the implementation of ICD-10-CM comes new verbiage to clarify that sequelae is a late effect. For Chapter 15, you will look to code O94 for Sequelae of complication of pregnancy, childbirth, and the pueperium. The codes are for use when an initial complication of pregnancy develops sequelae which requires care of treatment at a future date. These codes may also be used at any time after the initial postpartum period. Like all late effects codes, they are to be sequenced following the code that describes the sequelae of the complication.
Reference: ICD-10-CM Official Guidelines for Coding and Reporting; Chapter 15; Pages 52-60
http://www.cdc.gov/nchs/data/icd/icd10cm_guidelines_2014.pdf (PDF, 502 KB)
This commentary is a summary prepared by McKesson’s Business Performance Services division and highlights certain changes, not all changes, in 2014 CPT® codes relating to the specialty of academic, multi-specialty and office based
physicians. This commentary does not supplant the American Medical Association’s current listing of CPT® codes, its documentation in the annual CPT Changes publications, and other related publications from American Medical Association, which are the authoritative source for information about CPT® codes. Please refer to your 2014 CPT® Code Book, annual CPT® Changes publication, HCPCS Book and Payer Bulletins for additional information, including additions, deletions, changes and interpretations that may not be reflected in this document.
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