Pregnancy_ Childbirth and the Puerperium

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					Pregnancy, Childbirth
 and the Puerperium

    HS317b – Coding &
Classification of Health Data
O00 – O99 codes
   Classify pregnancy with abortive outcome,
    disorders predominantly related to pregnancy,
    maternal care, complications of labour and
    delivery and conditions related to the

   6th digit of the diagnostic code will indicate the
    episode of care – antepartum, delivery,
Stages of Pregnancy
   Pregnancy with abortive outcomes
     Complications

   Pregnancy – Antepartum
     Complications

   Pregnancy – Delivery
     Complications

   Pregnancy -- Postpartum
Episode of care – 6th digit
 ‘1’ Delivered, with or without mention of
  antepartum condition
 ‘2’ Delivered, with mention of postpartum
 ‘3’ Antepartum condition or complication
 ‘4’ Postpartum condition or complication
 ‘9’ Unspecified as to episode of care
Gestational Age
   Completed weeks after the onset of the last
    normal menstrual period to delivery

   Preterm
     Less  than 37 completed weeks
     i.e. O60.001 Preterm delivery, delivered, with or
      without mention of antepartum condition
   Term
     37
       completed weeks to less than 41
     completed weeks
   PostTerm
     Traditionally
                 at 42 completed weeks but may
     be assigned at 41 weeks if designated by a
          O48.001 Prolonged pregnancy, delivered, with or without mention of
           antepartum condition
   First trimester   < 13th week

   Second trimester 14th week—up to an
                     including 26th week

   Third trimester   > 26 week gestation
Stages of Labour & Delivery
   First stage
       Begins at onset of labour
       Ends at full dilation of cervix (10 cm)
   Second stage
       Begins at full dilation of cervix
       Ends at birth of the baby
   Third stage
       Begins at birth of baby
       Ends at delivery of placenta
Obstetrical Experience
   Antepartum
     Begins at conception
     Ends at complete dilation of cervix
   Intrapartum
     Begins at complete dilation of cervix
     Ends at Birth of infant
   Postpartum
     Beginsat birth of infant
     Ends as 42 days after birth of infant
Pregnancy with abortive outcome

   Includes codes in the range of O03 – O08
   Fourth digit of code
     Indicates   associated complications

   Spontaneous abortion, incomplete, without
    complications = O03.4
Pregnancy with abortive outcome

 Medical
 Ectopic & Molar
 Missed
 Spontaneous
 Failed Attempt
Ectopic/Molar Pregnancy
   Ectopic – pregnancy where fetus develops
    outside the uterus—in fallopian tubes, cervical
    canal, abdominal or pelvic cavity

   Molar – a tumorous growth of tissue from the
    placenta or afterbirth
          Excludes: malignant hydatidiform mole (D39.2)
    Missed or Spontaneous Abortion

   Missed abortion
     Earlyfetal death before completion of 20 weeks
      gestation with retention of dead fetus
          Excludes mole: hydatidiform (O01.-) and nonhydatidiform
   Spontaneous abortion
     Miscarriage (premature expulsion of fetus that
      occurs naturally and without cause)
Medical, Other, Failed Abortions

   Medical abortion O04-O07
     Elective   & therapeutic
   Other abortion
     Self-inflicted,   occurring after trauma
   Failed attempted abortion
     When  termination does not result in
      terminating the pregnancy
Complications following abortion
   ICD-10-CA makes a distinction between
    an episode of care at which the
    abortion/ectopic/molar pregnancy and any
    resulting complications are treated
    together and an episode of care for a
    complication of the abortion/ectopic/molar
    pregnancy treated previously
   Ruptured tubal pregnancy with shock
    (initial episode of care)
     O00.1  (M) Tubal pregnancy
     O08.3 (2) Shock following
      abortion/ectopic/molar pregnancy
   Incomplete spontaneous abortion with
    perforation of uterus (initial episode of care)
     O03.3(M)   Spontaneous abortion, incomplete, with
      other and unspecified complications
     O08.6 (2) Damage to pelvic organs and tissues
      following abortion/ectopic/molar pregnancy
Mrs. S. had a spontaneous abortion and
underwent a D & C in the first episode of care.
She was brought to ER two days after discharge
because she developed a fever and was
diagnosed with endometritis.

 O08.0(M)   Genital tract and pelvic infection following
  abortion and ectopic and molar pregnancy
Abortion & Sixth digit 9
   Sixth digit ‘9’
     Can  be used for additional OBS conditions with
       abortive outcome.
   Therapeutic abortion because of fetal anomalies
    (Trisomy 21)
     O04.9 (M) Medical Abortion
     O35.009 (1) Maternal care for chromosomal
      abnormalities in fetus.
Delivery in a completely normal case

   Normal delivery can include
     Spontaneous    vertex delivery
     Single term liveborn
     Healthy mother delivered
     Occiput posterior and occiput transverse not
      stated as persistent
     No fetal manipulation or instrumentation
Delivery in a completely normal case

   (M) Z37.0 Outcome of delivery, single live

   5.MD.50.~ ~ Manually assisted vaginal
    delivery (vertex)
Outcome of delivery – Z37.~
 Mandatory to code for every delivery
 When other codes from Chapter XV apply
  to the case
     Z37.~   is classified as a diagnosis type 3.
   There must be a corresponding
    intervention code for delivery selected as
    your principal procedure
   Certain obstetrical procedure do not
    contraindicate the use of Z37.0 as MRDx
     Induction   for convenience
     Artificial rupture of membranes
     Simple manual removal of placenta
     Episiotomy
     Requested Cesarean Section in the absence of any
   Mandatory intervention needed between the
    range of 5.MD.50.~~ to 5.MD.60.~~ for every
    delivery. Code as principal procedure
   5.MD.50.~~ manually assisted vaginal delivery
   5.MD.53.~~ Forceps traction & rotation
   5.MD.54.~~ Vacuum traction
   5.MD.55.~~ Combo – vacuum & forceps
   5.MD.56.~~ Breech delivery
   5.MD.60.~~ Caesarean Section
Folio lookup
 – – amnionitis O41.19
 – – anemia (conditions in D50 D64)
 – – atrophy (acute) (subacute) (yellow),
                 liver O26.6
 – – bicornis or bicornuate uterus O34.0
 – – bone and joint disorders of back,
     pelvis and lower limbs O99.8
 Pregnancy
 -conditions in
 – – – B50 B64, O98.6
 – – – D50 D64, O99.0
 – – – D65 D89, O99.1
 – – – E40 E46, O25
 – – – F00 F99, O99.3
   ‘1’ indicates episode in which mother has
    delivered with or without mention of
    antepartum condition
     Antepartum  condition with delivery
     Intrapartum obstetric condition
     Delivery NOS
     Pregnancy, delivered
Sixth Digit Combinations
   1 Delivery can be coded with
     ‘2’   Delivered with complication
   3 Antepartum condition can never be coded
    with ‘1’, ‘2’, ‘4’, or ‘9’
   4 Postpartum can never be used with ‘1’, ‘2’, ’3’,
    or ‘9’
   9 should never be used for inpatient care
    except when the outcome is abortive
Induction and Augmentation of
    5.AC.30.~~ Induction of labour
      Assign  when a patient presents for delivery
       with no physical signs of labour, and one of
       these interventions is performed to initiate
      Mandatory to code
   5.LD.31.~~ Augmentation of labour
     Assign when labor begins spontaneously
     Optional to code

   Augmentation and induction should not be coded
    on the same chart
     Facility
             directed as to code augmentation & induction
      in same episode
Sequencing Obstetrical Dx
   If episode of care includes non-
    instrumental, vaginal delivery of an infant
    but the mother was admitted for an
    antepartum condition that required
    treatment for more than five days before
    the birth, sequence the antepartum
    condition as MRDx
   In cases within the expected LOS (3 to 5
    days) where Caesarean section or
    instrumentation (forceps or vacuum) has
    been used, a diagnosis stating the
    indication for the intervention should be
    the MRDx
Exclusion/Inclusion notes
   O32.1 Maternal care for breech
     Excludes:    the listed conditions with
      obstructed labour (O64.-)
   O64.1 Obstructed labour due to breech
    presentation ++
Codes O32-O34 vs O64-O66
 Use these codes when mother is
  diagnosed with these conditions prior to the
  onset of labour.
 When labour has begun, medical
  intervention is required due to one of the
  conditions, the case should be classified
  from the range of O64-O66 Obstructed
   Code Z38.0~ for every newborn
     Z38.00 Singleton, born in hospital, delivered vaginally
     Z38.01 Singleton, born in hospital, delivered by
     Z38.1 Singleton, born outside hospital
     Z38.2 Singleton, unspecified as to place of birth
Diagnosis type 0
 If there is another contra-indication, Z38.0~
  must still be coded but as a diagnosis type
 No diagnosis type 3 is allowed for newborn
 Capture Z38 to distinguish babies born via
  caesarean section from those born
Low Birth Weight
   Infant delivered by cesarean section at 28
    weeks gestation weighing 1700 grams.

   When low birth weight is due to prematurity
    select two codes from P07 Disorders
    related to short gestation and low birth
    weight, NEC.
 P07.1 (M) Other low birth weight
 P07.3 (1) Other preterm infant
 Z38.01 (0) Singleton, born in hospital,
  delivered by cesarean section
Low Birth Weight
 WHO guidelines state that priority of
  assignment should be given to birth
 Birth weight of less than 2500 grams
Respiratory Distress (RDS) vs
Transient Tachypnea (TTN)
   Newborn diagnosed with respiratory
    distress syndrome. Surfactant is not
    administered. Baby is discharged home
    on day 3.
     P22.1 Transient Tachypnea of Newborn.
     Z38.0~ Singleton, born in hospital…
Standard for P22.0
   P22.0 Respiratory Distress Syndrome
     code when Surfactant is administered and
      diagnosis is documented as either RDS or
     Code when baby transferred to higher-level
      nursery or dies before Surfactant can be
   APGAR = American Pediatric Gross
    Assessment Record. It is a scoring system
    to estimate baby’s general condition at
    birth, at one minute and at five minutes
     Measures   baby’s heart rate, breathing, muscle
      tone, reflex response and colour
   GTPAL = Gravida Term Premature
    Abortion Live
Classification based on MRDx
   MCC 14 Pregnancy and Childbirth
     Factors   that impact CMG Assignment
       Complicating Cesarean Section
       Previous Cesarean Sections

     CMGs   600 - 624
Classification based on MRDx
   MCC 15 Newborns and Neonates with
    Conditions originating in the perinatal
     Nocomplexity is assigned (level 9)
     Weight impacts CGM Assignment
     CMGs 625 - 648