Chapter XV - Pregnancy, childbirth and the puerperium

Question 1

When should a code from category Z37.- Outcome of delivery be assigned and in what position?

Answer 1

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.

Question 2

What types of episode should codes in category Z37.- Outcome of delivery not be used for?

Answer 2

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.

Question 3

What does the term ‘abortion’ describe within the ICD-10 classification?

Answer 3

Both ‘miscarriage’ and ‘termination of pregnancy’

Question 4

What is meant by the term ‘live birth’?

Answer 4

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)

Question 5

What is gestational age?

Answer 5

The estimated age of a fetus, usually calculated by ultrasound scan.
GA is expressed in completed weeks.

Question 6

What are RPOC?

Answer 6

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.

Question 7

What is the puerperium?

Answer 7

the 42 days following the end of the second stage of labour

Question 8

When should the code O02.1 Missed abortion (missed miscarriage) be assigned?

Answer 8

Only when there has been no bleeding and no POC have been passed.

Question 9

When assigning a code for O03.- Spontaneous miscarriage, what does the 4th character code assignment show?

Answer 9

Whether the miscarriage was incomplete or complete and if there were any maternal complications.

Question 10

What is an incomplete miscarriage?

Answer 10

The miscarriage has started, bleeding is present but not all of the fetal tissue has been passed. RPOC are present.

Question 11

What is a complete miscarriage?

Answer 11

The pregnancy has been lost, the uterus is empty and there are no RPOC.

Question 12

What are other terms that may be used to describe a missed abortion/missed miscarriage?

Answer 12

• Early fetal demise
• Early uterine death
• Silent miscarriage
• Delayed miscarriage

Question 13

What is a missed miscarriage?

Answer 13

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

Question 14

What is a spontaneous miscarriage?

Answer 14

The expulsion of the baby or fetus before the 24th completed week without deliberate interference, and is a natural end to the pregnancy.

Question 15

How may Hydatidiform mole (O01) also be referred to?

Answer 15

Gestational trophoblastic disease

Question 16

How should an MTOP resulting in a live birth be coded?

Answer 16

• A code for the abortion O04-O06 +
• Z37.- Outcome of delivery (to show that it resulted in a live birth)

Question 17

When is the only time a code from O06.- Unspecified abortion can be assigned?

Answer 17

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.

Question 18

When should codes in category O20.- Haemorrhage in early pregnancy be assigned?

Answer 18

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).

Question 19

When can codes from category O21.- Excessive vomiting in pregnancy be assigned?

Answer 19

Only when the patient has been admitted because of, or is being treated for, the vomiting.

Question 20

How should Diabetes mellitus in pregnancy, childbirth and the puerperium always be coded?

Answer 20

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).

Question 21

How is ‘stillbirth’ defined?

Answer 21

A baby delivered with no signs of life, known to have died after 24 completed weeks of pregnancy.

Question 22

When must the code O48.X Prolonged pregnancy be assigned?

Answer 22

If the pregnancy exceeds 42 weeks or if the responsible consultant documents that the patient is ‘post-term’ or ‘post-dates’.

Question 23

When can codes in categories O80-O84 Delivery be assigned?

Answer 23

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.

Question 24

What is meant by the term ‘Grand multiparity’?

Answer 24

A woman who has given birth to five or more infants, alive or dead.

Question 25

What is meant by the term **'Elderly primagravida'**?

Answer 25

A woman **pregnant for the first time** who is **35 years of age or older**.

Question 26

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

Answer 26

Only if there are no other codes to be assigned from Chapter XV for complications or reasons for abnormal delivery.

Question 27

What does standard DCS.XV.25: Postpartum haemorrhage state about the use of codes at O72?

Answer 27

Only to be coded when documented as **PPH**. Levels of blood loss **must NOT be interpreted** by the coder to use these codes.

Question 28

When a patient has both a **post partum haemorrhage** and **morbidly adherant placenta**, how should this be coded?

Answer 28

Assign the code for morbidly adherant placenta (O43.2) **secondary** to the code for PPH (O72.0)

Question 29

What is the medical term for vomiting in pregnancy?

Answer 29

**Hyperemesis gravidarum**

Question 30

When must codes from category **O30.- Multiple gestation** be assigned and what are the rules about sequencing?

Answer 30

* **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

Question 31

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??

Answer 31

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.

Question 32

When is it permissible to assign **O36.4 Maternal care for intrauterine death**?

Answer 32

Only if it is **known before labour and delivery** that the fetus has no signs of life.

Question 33

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**?

Answer 33

If the **cause of death** is known, this shold be coded in **primary** **followed by O36.4** Maternal care for intrauterine death (+Z37.-)

Question 34

When can a code from O42.- Premature rupture of membranes be assigned?

Answer 34

Only for PROM **before the onset of labour**, regardless of the length of gestation.

Question 35

What is defined as **preterm delivery**?

Answer 35

Labour or delivery **before 37 completed weeks** gestation

Question 36

What is defined as **post-term delivery**?

Answer 36

Labour or delivery occuring **after 42 completed weeks** gestation

Question 37

What two terms can the consultant document for the coder to assign **O48.X Prolonged pregnancy**?

Answer 37

* **Post-term** * **Post-dates**

Question 38

When must code **O75.7 Vaginal delivery following previous caesarean section** be assigned?

Answer 38

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**.

Question 39

What does the abbreviation **VBAC** stand for?

Answer 39

**V**aginal **B**irth **A**fter **C**aesarean

Question 40

How are **complications of anaesthesia** coded in ICD-10? (when associated with pregnancy, childbirth & puerperium)

Answer 40

Coded according to the **stage of pregnancy when the anaesthesia was administered** not the stage the complication arose.

Question 41

How should **HIV in pregancy** be coded?

Answer 41

* **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**

Question 42

What does DCS.XV.32 state about coding **O99.0 Anaemia complicating pregnancy, childbirth and the puerperium**?

Answer 42

* 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

Question 43

When can **Z33.X Pregnant state**, incidental be assigned and in which position?

Answer 43

* 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

Question 44

When would a code from category **O99 Other maternal diseases classifiable elsewhere but complicating pregnancy, childbirth and the puerperium** be assigned?

Answer 44

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.

Question 45

What term is commonly used to describe **'false labour'**?

Answer 45

**Braxton-Hicks**