Chapter XV - Pregnancy, childbirth and the puerperium Flashcards
When should a code from category Z37.- Outcome of delivery be assigned and in what position?
Must be assigned on the mother’s delivery episode only, to identfy whether the delivery resulted in a liveborn or stillborn infant(s).
Can be sequenced in any secondary position, NEVER in primary.
What types of episode should codes in category Z37.- Outcome of delivery not be used for?
Must not be used on patients who have undergone termination of pregnancy or suffered a miscarriage that has resulted in the delivery of a dead fetus whilst in hospital.
What does the term ‘abortion’ describe within the ICD-10 classification?
Both ‘miscarriage’ and ‘termination of pregnancy’
What is meant by the term ‘live birth’?
Complete expulsion or extraction of a fetus from its mother, which, after seperation, breathes or shows any other evidence of life (irrespective of the duration of pregnancy)
What is gestational age?
The estimated age of a fetus, usually calculated by ultrasound scan.
GA is expressed in completed weeks.
What are RPOC?
Retained products of conception - the retention of any part of the placental tissue, membranes, gestation sac or fetal pole following miscarriage, TOP or delivery of pregnancy.
What is the puerperium?
the 42 days following the end of the second stage of labour
When should the code O02.1 Missed abortion (missed miscarriage) be assigned?
Only when there has been no bleeding and no POC have been passed.
When assigning a code for O03.- Spontaneous miscarriage, what does the 4th character code assignment show?
Whether the miscarriage was incomplete or complete and if there were any maternal complications.
What is an incomplete miscarriage?
The miscarriage has started, bleeding is present but not all of the fetal tissue has been passed. RPOC are present.
What is a complete miscarriage?
The pregnancy has been lost, the uterus is empty and there are no RPOC.
What are other terms that may be used to describe a missed abortion/missed miscarriage?
- Early fetal demise
- Early uterine death
- Silent miscarriage
- Delayed miscarriage
What is a missed miscarriage?
The retention of a dead fetus before 24 completed weeks of gestation.
Diagnosed before any bleeding has taken place, e.g. at a routine antenatal scan
What is a spontaneous miscarriage?
The expulsion of the baby or fetus before the 24th completed week without deliberate interference, and is a natural end to the pregnancy.
How may Hydatidiform mole (O01) also be referred to?
Gestational trophoblastic disease
How should an MTOP resulting in a live birth be coded?
- A code for the abortion O04-O06 +
- Z37.- Outcome of delivery (to show that it resulted in a live birth)
When is the only time a code from O06.- Unspecified abortion can be assigned?
Inadvertent loss of pregnancy due to direct cause.
When a patient undergoes uterine surgery (eg hysterectomy) and the pregnancy is unavoidably terminated due to the nature of the procedure.
When should codes in category O20.- Haemorrhage in early pregnancy be assigned?
Must be used for any vaginal bleeding before 24 completed weeks of gestation.
Exception - when the pregnancy proceeds to abortive outcome (use O00-O08 instead).
When can codes from category O21.- Excessive vomiting in pregnancy be assigned?
Only when the patient has been admitted because of, or is being treated for, the vomiting.
How should Diabetes mellitus in pregnancy, childbirth and the puerperium always be coded?
Using a code from category O24.- Diabetes mellitus in pregnancy
If there are manifestations of the diabetes, these must be coded in addition (with D&A codes where appropriate).
How is ‘stillbirth’ defined?
A baby delivered with no signs of life, known to have died after 24 completed weeks of pregnancy.
When must the code O48.X Prolonged pregnancy be assigned?
If the pregnancy exceeds 42 weeks or if the responsible consultant documents that the patient is ‘post-term’ or ‘post-dates’.
When can codes in categories O80-O84 Delivery be assigned?
Only when the only information recorded is a statement of ‘delivery’ or when the method of delivery has been recorded and the patient has no other conditions classifiable to Chapter XV.
What is meant by the term ‘Grand multiparity’?
A woman who has given birth to five or more infants, alive or dead.
What is meant by the term ‘Elderly primagravida’?
A woman pregnant for the first time who is 35 years of age or older.
When can the following codes be assigned in the primary position on a delivery episode?
* O80.0 Spontaneous vertex delivery
* O82.0 Delivery by elective caesarean section
* O30.- Multiple gestation
Only if there are no other codes to be assigned from Chapter XV for complications or reasons for abnormal delivery.
What does standard DCS.XV.25: Postpartum haemorrhage state about the use of codes at O72?
Only to be coded when documented as PPH.
Levels of blood loss must NOT be interpreted by the coder to use these codes.
When a patient has both a post partum haemorrhage and morbidly adherant placenta, how should this be coded?
Assign the code for morbidly adherant placenta (O43.2) secondary to the code for PPH (O72.0)
What is the medical term for vomiting in pregnancy?
Hyperemesis gravidarum
When must codes from category O30.- Multiple gestation be assigned and what are the rules about sequencing?
- O30.-must be recorded on the mothers delivery episode for **ALL multiple births **
- Can be in primary if no complications (followed by Z37.-)
- If the patient has any other conditions from Chapter XV on the delivery episode then O30.- must be recorded secondary to these
When can a code for Obstructed labour (O64-O66) be assigned rather than a code from O32-O34 Maternal care for known or suspected malpresentation of fetus, diproportion and abnormality of pelvic organs??
Only when the responsible consultant confirms that the labour is obstructed or if the ICD-10 trail directs the coder to an obstructed labour code.
When is it permissible to assign O36.4 Maternal care for intrauterine death?
Only if it is known before labour and delivery that the fetus has no signs of life.
What are the sequencing rules for assigning O36.4 Maternal care for intrauterine death on the mums delivery episode when the cause of death is known?
If the cause of death is known, this shold be coded in primary followed by O36.4 Maternal care for intrauterine death (+Z37.-)
When can a code from O42.- Premature rupture of membranes be assigned?
Only for PROM before the onset of labour, regardless of the length of gestation.
What is defined as preterm delivery?
Labour or delivery before 37 completed weeks gestation
What is defined as post-term delivery?
Labour or delivery occuring after 42 completed weeks gestation
What two terms can the consultant document for the coder to assign O48.X Prolonged pregnancy?
- Post-term
- Post-dates
When must code O75.7 Vaginal delivery following previous caesarean section be assigned?
Any time it is documented that the mother has delivered vaginally following a previous C-section (regardless of how long ago the c-section was).
Can be primary or secondary.
What does the abbreviation VBAC stand for?
Vaginal Birth After Caesarean
How are complications of anaesthesia coded in ICD-10? (when associated with pregnancy, childbirth & puerperium)
Coded according to the stage of pregnancy when the anaesthesia was administered not the stage the complication arose.
How should HIV in pregancy be coded?
-
O98.7 HIV disease complicating pregnancy, childbirth and the puerperium
followed by a code for the type of HIV… - Symptomatic HIV - add additional code from B20-B24 in a secondary position
- Asymptomativ HIV - add Z21.X Asymptomatic HIV infection status in a secondary position
What does DCS.XV.32 state about coding O99.0 Anaemia complicating pregnancy, childbirth and the puerperium?
- Must only be assigned when it is document that the aneamia is complicating pregnancy, childbirth or the puerperium.
- Should not code this for statements of ‘low Hb’ or ‘sent home on iron tablets’
- An additional code from D50-D64.8 must be used if the type of anaemia is known
When can Z33.X Pregnant state, incidental be assigned and in which position?
- Only when a pregnant patient is treated for an unrelated condition that does not complicate the management of the pregnancy (e.g. fracture)
- Must NEVER be in a primary position
When would a code from category O99 Other maternal diseases classifiable elsewhere but complicating pregnancy, childbirth and the puerperium be assigned?
For conditions that complicate the pregnant state, are aggravated by the pregancy, or are the main reason for obstetric care which are not classified elsewhere in Chapter XV.
An additional code must be assigned to identify the specific condition where it adds information.
What term is commonly used to describe ‘false labour’?
Braxton-Hicks
