• Register to Access the Free Forums and 3 Free CEUs!

    To view the content for the 3 free CEUs, please sign up today.

    CLICK HERE TO REGISTER
  • Missing Access To A Course, Blitz or Exam? Have Technical Issues? Open a Help Desk Ticket
    Please Do Not Post in the Community About Access or Technical Issues
    CCO Business Hours for Help Desk and Coaching: Mon-Fri 9am-4pm Eastern

Resource OBGYN Coding

ICD-10-CM guidelines for Chapter 15

15. Chapter 15: Pregnancy, Childbirth, and the Puerperium
(O00-O9A)
a. General Rules for Obstetric Cases
1) Codes from chapter 15 and sequencing priority
Obstetric cases require codes from chapter 15, codes in the
range O00-O9A, Pregnancy, Childbirth, and the Puerperium.
Chapter 15 codes have sequencing priority over codes from
other chapters. Additional codes from other chapters may be
used in conjunction with chapter 15 codes to further specify
conditions. Should the provider document that the pregnancy is
incidental to the encounter, then code Z33.1, Pregnant state,
incidental, should be used in place of any chapter 15 codes. It is
the provider’s responsibility to state that the condition being
treated is not affecting the pregnancy.
2) Chapter 15 codes used only on the maternal record
Chapter 15 codes are to be used only on the maternal record,
never on the record of the newborn.
3) Final character for trimester
The majority of codes in Chapter 15 have a final character
indicating the trimester of pregnancy. The timeframes for the
trimesters are indicated at the beginning of the chapter. If
trimester is not a component of a code, it is because the
condition always occurs in a specific trimester, or the concept of
trimester of pregnancy is not applicable. Certain codes have
characters for only certain trimesters because the condition does
not occur in all trimesters, but it may occur in more than just
one.
Assignment of the final character for trimester should be based
on the provider’s documentation of the trimester (or number of
weeks) for the current admission/encounter. This applies to the
assignment of trimester for pre-existing conditions as well as
those that develop during or are due to the pregnancy. The
provider’s documentation of the number of weeks may be used
to assign the appropriate code identifying the trimester.
Whenever delivery occurs during the current admission, and
there is an “in childbirth” option for the obstetric complication
being coded, the “in childbirth” code should be assigned.
4) Selection of trimester for inpatient admissions that
encompass more than one trimester
In instances when a patient is admitted to a hospital for
complications of pregnancy during one trimester and remains in
the hospital into a subsequent trimester, the trimester character
for the antepartum complication code should be assigned on the
basis of the trimester when the complication developed, not the
trimester of the discharge. If the condition developed prior to
the current admission/encounter or represents a pre-existing
condition, the trimester character for the trimester at the time of
the admission/encounter should be assigned.
5) Unspecified trimester
Each category that includes codes for trimester has a code for
“unspecified trimester.” 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.
6) 7th character for Fetus Identification
Where applicable, a 7th character is to be assigned for certain
categories (O31, O32, O33.3 - O33.6, O35, O36, O40, O41,
O60.1, O60.2, O64, and O69) to identify the fetus for which the
complication code applies.
th Assign 7 character “0”:
• For single gestations
• When the documentation in the record is insufficient to
determine the fetus affected and it is not possible to
obtain clarification.
• When it is not possible to clinically determine which
fetus is affected.
b. Selection of OB Principal or First-listed Diagnosis
1) Routine outpatient prenatal visits
For routine outpatient prenatal visits when no complications are
present, a code from category Z34, Encounter for supervision of
ICD-10-CM Official Guidelines for Coding andReporting
FY 2021
Page 65 of 126
FY 2021
Page 66 of 126
normal pregnancy, should be used as the first-listed diagnosis.
These codes should not be used in conjunction with chapter 15
codes.
2) Supervision of High-Risk Pregnancy
Codes from category O09, Supervision of high-risk pregnancy,
are intended for use only during the prenatal period. For
complications during the labor or delivery episode as a result of
a high-risk pregnancy, assign the applicable complication codes
from Chapter 15. If there are no complications during the labor
or delivery episode, assign code O80, Encounter for full-term
uncomplicated delivery.
For routine prenatal outpatient visits for patients with high-risk
pregnancies, a code from category O09, Supervision of
high-risk pregnancy, should be used as the first-listed diagnosis.
Secondary chapter 15 codes may be used in conjunction with
these codes if appropriate.
3) Episodes when no delivery occurs
In episodes when no delivery occurs, the principal diagnosis
should correspond to the principal complication of the
pregnancy which necessitated the encounter. Should more than
one complication exist, all of which are treated or monitored,
any of the complication codes may be sequenced first.
4) When a delivery occurs
When an obstetric patient is admitted and delivers during that
admission, the condition that prompted the admission should be
sequenced as the principal diagnosis. If multiple conditions
prompted the admission, sequence the one most related to the
delivery as the principal diagnosis. A code for any complication
of the delivery should be assigned as an additional diagnosis. In
cases of cesarean delivery, if the patient was admitted with a
condition that resulted in the performance of a cesarean
procedure, that condition should be selected as the principal
diagnosis. If the reason for the admission was unrelated to the
condition resulting in the cesarean delivery, the condition
related to the reason for the admission should be selected as the
principal diagnosis.
5) Outcome of delivery
A code from category Z37, Outcome of delivery, should be
included on every maternal record when a delivery has
occurred. These codes are not to be used on subsequent records
or on the newborn record.
ICD-10-CM Official Guidelines for Coding andReporting
c. Pre-existing conditions versus conditions due to the
pregnancy
Certain categories in Chapter 15 distinguish between conditions of the
mother that existed prior to pregnancy (pre-existing) and those that are
a direct result of pregnancy. When assigning codes from Chapter 15, it
is important to assess if a condition was pre-existing prior to pregnancy
or developed during or due to the pregnancy in order to assign the
correct code.
Categories that do not distinguish between pre-existing and pregnancyrelated conditions may be used for either. It is acceptable to use codes
specifically for the puerperium with codes complicating pregnancy and
childbirth if a condition arises postpartum during the delivery
encounter.
d. Pre-existing hypertension in pregnancy
Category O10, Pre-existing hypertension complicating pregnancy,
childbirth and the puerperium, includes codes for hypertensive heart
and hypertensive chronic kidney disease. When assigning one of the
O10 codes that includes hypertensive heart disease or hypertensive
chronic kidney disease, it is necessary to add a secondary code from the
appropriate hypertension category to specify the type of heart failure or
chronic kidney disease.
See Section I.C.9. Hypertension.
e. Fetal Conditions Affecting the Management of the Mother
1) Codes from categories O35 and O36
Codes from categories O35, Maternal care for known or
suspected fetal abnormality and damage, and O36, Maternal
care for other fetal problems, are assigned only when the fetal
condition is actually responsible for modifying the management
of the mother, i.e., by requiring diagnostic studies, additional
observation, special care, or termination of pregnancy. The fact
that the fetal condition exists does not justify assigning a code
from this series to the mother’s record.
2) In utero surgery
In cases when surgery is performed on the fetus, a diagnosis
code from category O35, Maternal care for known or suspected
fetal abnormality and damage, should be assigned identifying
the fetal condition. Assign the appropriate procedure code for
the procedure performed.
ICD-10-CM Official Guidelines for Coding andReporting
FY 2021
Page 67 of 126
ICD-10-CM Official Guidelines for Coding andReporting
FY 2021
Page 68 of 126
No code from Chapter 16, the perinatal codes, should be used
on the mother’s record to identify fetal conditions. Surgery
performed in utero on a fetus is still to be coded as an obstetric
encounter.
f. HIV Infection in Pregnancy, Childbirth and the
Puerperium
During pregnancy, childbirth or the puerperium, a patient admitted
because of an HIV-related illness should receive a principal diagnosis
from subcategory O98.7-, Human immunodeficiency [HIV] disease
complicating pregnancy, childbirth and the puerperium, followed by the
code(s) for the HIV-related illness(es).
Patients with asymptomatic HIV infection status admitted during
pregnancy, childbirth, or the puerperium should receive codes of
O98.7- and Z21, Asymptomatic human immunodeficiency virus [HIV]
infection status.
g. Diabetes mellitus in pregnancy
Diabetes mellitus is a significant complicating factor in pregnancy.
Pregnant women who are diabetic should be assigned a code from
category O24, Diabetes mellitus in pregnancy, childbirth, and the
puerperium, first, followed by the appropriate diabetes code(s) (E08-
E13) from Chapter 4.
h. Long term use of insulin and oral hypoglycemics
See section I.C.4.a.3 for information on the long-term use of insulin and
oral hypoglycemics.
i. Gestational (pregnancy induced) diabetes
Gestational (pregnancy induced) diabetes can occur during the second
and third trimester of pregnancy in women who were not diabetic prior
to pregnancy. Gestational diabetes can cause complications in the
pregnancy similar to those of pre-existing diabetes mellitus. It also puts
the woman at greater risk of developing diabetes after the pregnancy.
Codes for gestational diabetes are in subcategory O24.4, Gestational
diabetes mellitus. No other code from category O24, Diabetes mellitus
in pregnancy, childbirth, and the puerperium, should be used with a
code from O24.4.
The codes under subcategory O24.4 include diet controlled, insulin
controlled, and controlled by oral hypoglycemic drugs. If a patient with
gestational diabetes is treated with both diet and insulin, only the code
for insulin-controlled is required. If a patient with gestational diabetes
is treated with both diet and oral hypoglycemic medications, only the
code for "controlled by oral hypoglycemic drugs" is required. Code
Z79.4, Long-term (current) use of insulin or code Z79.84, Long-term
(current) use of oral hypoglycemic drugs, should not be assigned with
codes from subcategory O24.4.
An abnormal glucose tolerance in pregnancy is assigned a code from
subcategory O99.81, Abnormal glucose complicating pregnancy,
childbirth, and the puerperium.
j. Sepsis and septic shock complicating abortion, pregnancy,
childbirth and the puerperium
When assigning a chapter 15 code for sepsis complicating abortion,
pregnancy, childbirth, and the puerperium, a code for the specific type
of infection should be assigned as an additional diagnosis. If severe
sepsis is present, a code from subcategory R65.2, Severe sepsis, and
code(s) for associated organ dysfunction(s) should also be assigned as
additional diagnoses.
k. Puerperal sepsis
Code O85, Puerperal sepsis, should be assigned with a secondary code
to identify the causal organism (e.g., for a bacterial infection, assign a
code from category B95-B96, Bacterial infections in conditions
classified elsewhere). A code from category A40, Streptococcal sepsis,
or A41, Other sepsis, should not be used for puerperal sepsis. If
applicable, use additional codes to identify severe sepsis (R65.2-) and
any associated acute organ dysfunction.
Code O85 should not be assigned for sepsis following an obstetrical
procedure (See Section I.C.1.d.5.b., Sepsis due to a postprocedural
infection).
l. Alcohol, tobacco and drug use during pregnancy,
childbirth and the puerperium
1) Alcohol use during pregnancy, childbirth and the
puerperium
Codes under subcategory O99.31, Alcohol use complicating
pregnancy, childbirth, and the puerperium, should be assigned
for any pregnancy case when a mother uses alcohol during the
pregnancy or postpartum. A secondary code from category F10,
Alcohol related disorders, should also be assigned to identify
manifestations of the alcohol use.
2) Tobacco use during pregnancy, childbirth and the
puerperium
ICD-10-CM Official Guidelines for Coding andReporting
FY 2021
Page 69 of 126
Codes under subcategory O99.33, Smoking (tobacco)
complicating pregnancy, childbirth, and the puerperium, should
be assigned for any pregnancy case when a mother uses any
type of tobacco product during the pregnancy or postpartum.
A secondary code from category F17, Nicotine dependence,
should also be assigned to identify the type of nicotine
dependence.
3) Drug use during pregnancy, childbirth and the
puerperium
Codes under subcategory O99.32, Drug use complicating
pregnancy, childbirth, and the puerperium, should be assigned
for any pregnancy case when a mother uses drugs during the
pregnancy or postpartum. This can involve illegal drugs, or
inappropriate use or abuse of prescription drugs. Secondary
code(s) from categories F11-F16 and F18-F19 should also be
assigned to identify manifestations of the drug use.
m. Poisoning, toxic effects, adverse effects and underdosing in
a pregnant patient
A code from subcategory O9A.2, Injury, poisoning and certain other
consequences of external causes complicating pregnancy, childbirth,
and the puerperium, should be sequenced first, followed by the
appropriate injury, poisoning, toxic effect, adverse effect or
underdosing code, and then the additional code(s) that specifies the
condition caused by the poisoning, toxic effect, adverse effect or
underdosing.
See Section I.C.19. Adverse effects, poisoning, underdosing and toxic
effects.
n. Normal Delivery, Code O80
1) Encounter for full term uncomplicated delivery
Code O80 should be assigned when a woman is admitted for a
full-term normal delivery and delivers a single, healthy infant
without any complications antepartum, during the delivery, or
postpartum during the delivery episode. Code O80 is always a
principal diagnosis. It is not to be used if any other code from
chapter 15 is needed to describe a current complication of the
antenatal, delivery, or postnatal period. Additional codes from
other chapters may be used with code O80 if they are not related
to or are in any way complicating the pregnancy.
2) Uncomplicated delivery with resolved antepartum
complication
ICD-10-CM Official Guidelines for Coding andReporting
FY 2021
Page 70 of 126
ICD-10-CM Official Guidelines for Coding andReporting
FY 2021
Page 71 of 126
Code O80 may be used if the patient had a complication at some
point during the pregnancy, but the complication is not present
at the time of the admission for delivery.
3) Outcome of delivery for O80
Z37.0, Single live birth, is the only outcome of delivery code
appropriate for use with O80.
o. The Peripartum and Postpartum Periods
1) Peripartum and Postpartum periods
The postpartum period begins immediately after delivery and
continues for six weeks following delivery. The peripartum
period is defined as the last month of pregnancy to five months
postpartum.
2) Peripartum and postpartum complication
A postpartum complication is any complication occurring
within the six-week period.
3) Pregnancy-related complications after 6-week period
Chapter 15 codes may also be used to describe
pregnancy-related complications after the peripartum or
postpartum period if the provider documents that a condition is
pregnancy related.
4) Admission for routine postpartum care following
delivery outside hospital
When the mother delivers outside the hospital prior to
admission and is admitted for routine postpartum care and no
complications are noted, code Z39.0, Encounter for care and
examination of mother immediately after delivery, should be
assigned as the principal diagnosis.
5) Pregnancy associated cardiomyopathy
Pregnancy associated cardiomyopathy, code O90.3, is unique in
that it may be diagnosed in the third trimester of pregnancy but
may continue to progress months after delivery. For this reason,
it is referred to as peripartum cardiomyopathy. Code O90.3 is
only for use when the cardiomyopathy develops as a result of
pregnancy in a woman who did not have pre-existing heart
disease.
ICD-10-CM Official Guidelines for Coding andReporting
FY 2021
Page 72 of 126
p. Code O94, Sequelae of complication of pregnancy,
childbirth, and the puerperium
1) Code O94
Code O94, Sequelae of complication of pregnancy, childbirth,
and the puerperium, is for use in those cases when an initial
complication of a pregnancy develops a sequelae requiring care
or treatment at a future date.
2) After the initial postpartum period
This code may be used at any time after the initial postpartum
period.
3) Sequencing of Code O94
This code, like all sequela codes, is to be sequenced following
the code describing the sequelae of the complication.
q. Termination of Pregnancy and Spontaneous abortions
1) Abortion with Liveborn Fetus
When an attempted termination of pregnancy results in a
liveborn fetus, assign code Z33.2, Encounter for elective
termination of pregnancy and a code from category Z37,
Outcome of Delivery.
2) Retained Products of Conception following an abortion
Subsequent encounters for retained products of conception
following a spontaneous abortion or elective termination of
pregnancy, without complications are assigned O03.4,
Incomplete spontaneous abortion without complication, or code
O07.4, Failed attempted termination of pregnancy without
complication. This advice is appropriate even when the patient
was discharged previously with a discharge diagnosis of
complete abortion. If the patient 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 (e.g., O03.-, O04.-,
O07.-) instead of code O03.4 or O07.4.
3) Complications leading to abortion
Codes from Chapter 15 may be used as additional codes to
identify any documented complications of the pregnancy in
conjunction with codes in categories in O04, O07 and O08.
ICD-10-CM Official Guidelines for Coding andReporting
FY 2021
Page 73 of 126
r. Abuse in a pregnant patient
For suspected or confirmed cases of abuse of a pregnant patient, a
code(s) from subcategories O9A.3, Physical abuse complicating
pregnancy, childbirth, and the puerperium, O9A.4, Sexual abuse
complicating pregnancy, childbirth, and the puerperium, and O9A.5,
Psychological abuse complicating pregnancy, childbirth, and the
puerperium, should be sequenced first, followed by the appropriate
codes (if applicable) to identify any associated current injury due to
physical abuse, sexual abuse, and the perpetrator of abuse.
See Section I.C.19. Adult and child abuse, neglect and other
maltreatment.
s. COVID-19 infection in pregnancy, childbirth, and the
puerperium
During pregnancy, childbirth or the puerperium, when COVID-19
is the reason for admission/encounter , code O98.5-, Other viral
diseases complicating pregnancy, childbirth and the puerperium,
should be sequenced as the principal/first-listed diagnosis, and code
U07.1, COVID-19, and the appropriate codes for associated
manifestation(s) should be assigned as additional diagnoses. Codes
from Chapter 15 always take sequencing priority.
If the reason for admission/encounter is unrelated to COVID-19 but
the patient tests positive for COVID-19 during the
admission/encounter, the appropriate code for the reason for
admission/encounter should be sequenced as the principal/firstlisted diagnosis, and codes O98.5- and U07.1, as well as the
appropriate codes for associated COVID-19 manifestations, should
be assigned as additional diagnoses.





 

Lori

Moderator
Staff member

What is or is not included for Billing Guidelines Ob/Gyn Global (2021)​

List of includes/excludes.

Global/Non-Global, Obstetrical Service.

1. Antepartum care

2. Delivery services

3. Postpartum care

1. Global OB Care

2. Non-global OB care or partial services


Services Included In Global Obstetrical Package

  • Routine prenatal visits until delivery, after the first three antepartum visits.
  • Recording of weight, blood pressures, and fetal heart tones.
  • Admission to the hospital including history and physical.
  • Inpatient (E/M) service provided within 24 hours of delivery.
  • Management of uncomplicated labor.
  • Vaginal or cesarean section delivery.
  • Delivery of placenta (CPT code 59414).
  • Administration/induction of intravenous oxytocin (CPT code 96365-96367).
  • Insertion of a cervical dilator on the same date as delivery (CPT code 59200).
  • Repair of first or second-degree lacerations .
  • A simple removal of cerclage (not under anesthesia).
  • Uncomplicated inpatient visits following delivery
  • Routine outpatient E/M services provided within 42 days following delivery.
  • Postpartum care after vaginal or cesarean section delivery (CPT code 59430).

Services Excluded From The Global Obstetrical Package

The following services are excluded from the global OB package (CPT codes 59400, 59510, 59610, 59618) and may be reported separately.
  • First three antepartum E&M visits
  • Laboratory tests
  • Maternal or fetal echography procedures (CPT codes 76801, 76802, 76805, 76810, 76811, 76812, 76813, 76814, 76815, 76816, 76817, 76820, 76821, 76825, 76826, 76827 and 76828)
  • Amniocentesis, any method (CPT codes 59000 or 59001)
  • Amniofusion (CPT code 59070)
  • Chorionic villus sampling (CPT code 59015)
  • Fetal contraction stress test (CPT code 59020)
  • Fetal non-stress test (CPT code 59025)
  • External cephalic version (CPT code 59412)
  • Insertion of cervical dilator (CPT code 59200) more than 24 hr before delivery
  • E&M services which is unrelated to the pregnancy (e.g. UTI, Asthma) during antepartum or postpartum care.
  • Additional E/M visits for complications or high-risk monitoring resulting in greater than the typical 13 antepartum visits. However, these E/M services should not be reported until after the patient delivers. Append modifier 25 to identify these visits as separately identifiable from routine antepartum visits.
  • Inpatient E/M services provided more than 24 hrs before the delivery
  • Management of surgical problems arising during pregnancy (e.g. Cholecystectomy, appendicitis, ruptured uterus)
 

Lori

Moderator
Staff member
Learn about Prenatal & Postpartum care.

Understanding Terms for OBGYN.

What are the stages of pregnancy & childbirth.

• Pregnancy — the period of time between conception and delivery in which a fetus develops inside the uterus. This time is divided into trimesters.
• Childbirth — begins with the true onset of labor and ends after the delivery of the baby and placenta. This is divided into three stages for vaginal deliveries.
• Puerperium — the approximately 6-week period after delivery when the mother’s body readjusts to a non-pregnant state.
• Products of conception — tissues that develop during pregnancy, such as fetal tissue, placenta tissue, etc.
• Ectopic pregnancy — a pregnancy in which the fertilized egg implants outside of the uterus.
• Abortion — the premature passing of the products of conception, typically prior to 20 weeks (may be induced or spontaneous).
• Perinatal — the period of time before birth through the 28th day following birth.
• Congenital — a condition that is present from birth.
• Gestational age — the age, reported in weeks, of the developing fetus. This begins on the first day of the mother’s last menstrual period and ends at birth (~40 weeks).
Note:
• A missed abortion is a type of miscarriage, also referred to as a delayed miscarriage.
• A spontaneous abortion is a spontaneous loss of the fetus before the 20th week of pregnancy, also referred to as a miscarriage.
• A threatened abortion refers to a hemorrhage in early pregnancy, also referred to as a threatened miscarriage.


Screen Shot 2021-11-23 at 10.52.41 AM.png

 
Top