Chapter 15: Pregnancy, Childbirth, and the Puerperium

Question 1

Codes from chapter 15 and sequencing priority

Answer 1

Chapter 15 codes have sequencing priority over codes from other chapters.

Additional codes form other chapters may be used in conjunction with chapter 15 codes to further specify.

Question 2

Should the provider document that the pregnancy is incidental to the encounter, then code ______

Answer 2

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.

Question 3

Chapter 15 codes are to only be used on what record?

Answer 3

Maternal. Never for newborn.

Question 4

The majority of codes in Chapter 15 have a final character indicating

Answer 4

the trimester of pregnancy.

If the 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.

Question 5

When a patient is admitted to a hospital for complications of pregnancy during one trimester and remains in the hospital into a subsequent trimester… what trimester is coded?

Answer 5

the trimester character for the antepartum complication code should be assigned on the basis of the trimester when the complication developed, NOT the trimester discharged.

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

Question 6

For outpatient routine prenatal visits when no complications are present, a code from category ….

Answer 6

Z34 Encounter for supervision of normal pregnancy, should be used as the first-listed diagnosis

Question 7

Codes from category O09, supervision of high-risk pregnancy, are intended for use only _____

Answer 7

during the prenatal period.

Question 8

When an obstetric patient is admitted and delivers during that admission, what is sequenced as the PDX?

Answer 8

the condition that prompted the admission should be sequenced as the principal diagnosis.

Question 9

What code is used for outcome of delivery?

Answer 9

Code 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.

Question 10

When assigning one of the O10 codes that include hypertensive heart disease and hypertensive chronic kidney disease- how should it be coded?

Answer 10

it is necessary to add a secondary code from the appropriate hypertension category to specify the type of heart failure or chronic kidney disease.

Question 11

Codes from O35, Maternal care from known or suspected fetal abnormality and damage, and O36, Maternal care for other fetal problems, are assigned when?

Answer 11

are assigned only when the fetal condition is actually responsible for modifying the management of the mother 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 mothers record.

Question 12

What code category is used when surgery is performed on fetus?

Answer 12

O35, Maternal care for known or suspected fetal abnormality and damage, should be assigned identifying the fetal condition.
No code from chapter 16.

Procedure performed in utero on a fetus is still to be coded as an obstetric encounter.

Question 13

During pregnancy, childbirth or the puerperium, a patient admitted because of an HIV-related illness should receive what PDX?

Answer 13

should receive a principal diagnosis from subcategory O98.7-, Human immunodeficiency HIV disease complicating pregnancy, childbirth and the puerperium, followed by the codes from the HIV-related illness(es).

If asymptomatic HIV infection status admitted during pregnancy childbirth or puerperium should receive codes of O98.7- Z21 Asymptomatic HIV

Question 14

Pregnant women who are diabetic should be assigned a code from ?

Answer 14

category O24, Diabetes mellitus in pregnancy, childbirth, and the puerperium, first, followed by the appropriate diabetes code(s) (E08-E13) from chapter 4.

Question 15

When can gestational diabetes occur?

Answer 15

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 after the pregnancy.

Codes for gestational diabetes are in subcategory O24.4 no other code from O24 should be used with O24.4

Question 16

If a patient with gestational diabetes is treated with both diet and insulin, only code _____

If a patient with gestational diabetes is treated with both diet and oral hypoglycemic medications, only code__

Answer 16

only the code for insulin-controlled is required.

only the code for oral hypoglycemic drugs is required.

do not use long term use of insulin (Z79.84) with O24.4

Question 17

An abnormal glucose tolerance in pregnancy is assigned a code from subcategory ____

Answer 17

O99.81, Abnormal. glucose complicating pregnancy, childbirth, and the puerperium.

Question 18

Code O85, Puerperal sepsis, should be assigned with a secondary code to identify the causal organism with what else?

Answer 18

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.

Question 19

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.
What is the secondary code?

Answer 19

A secondary code from category F10, Alcohol related disorders, should also be assigned to identify manifestations of the alcohol use.

Question 20

A code from subcategory O9A.2, Injury, poisoning and certain other consequences of external causes complicating pregnancy, childbirth, and the puerperium, should be sequenced ? What is the additional code?

Answer 20

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.

Question 21

What code is used for 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?

Answer 21

O80. It is always principal.

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 perinatal 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.

Question 22

Uncomplicated delivery with resolved antepartum complication – which code can be used?

Answer 22

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.

Question 23

When does the postpartum period begin?

Answer 23

immediately after delivery and continues for six weeks following delivery.

Question 24

The peripartum period is defined as

Answer 24

the last month of pregnancy to five months postpartum.

Question 25

Peripartum and postpartum complication

Answer 25

A postpartum complication is any complication occurring within the six-week period.

Question 26

What to use for Pregnancy-related complications after 6 week period?

Answer 26

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.

Question 27

Admission for routine postpartum care following

delivery outside hospital – What code is used?

Answer 27

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.

Question 28

Pregnancy associated cardiomyopathy is coded as?

Answer 28

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.

Question 29

Code O94 is used for?

Answer 29

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.

Question 30

When an attempted termination of pregnancy results in a liveborn fetus, assign code

Answer 30

Z33.2, Encounter for elective termination of pregnancy and a code from category Z37, Outcome of Delivery.

Question 31

Subsequent encounters for retained products of conception following a spontaneous abortion or elective termination of pregnancy, without complications are assigned

Answer 31

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 in category O03 or O07 instead of code O03.4 or O07.4.

Question 32

If it is an abuse case what two codes are reported?

Answer 32

Abuse code and injury as secondary.