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Pregnancy, Childbirth and the Puerperium

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 puerperium

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Pregnancy, Childbirth and the Puerperium

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  1. Pregnancy, Childbirth and the Puerperium HS317b – Coding & Classification of Health Data

  2. 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 puerperium • 6th digit of the diagnostic code will indicate the episode of care – antepartum, delivery, postpartum

  3. Stages of Pregnancy • Pregnancy with abortive outcomes • Complications • Pregnancy – Antepartum • Complications • Pregnancy – Delivery • Complications • Pregnancy -- Postpartum

  4. Episode of care – 6th digit • ‘1’ Delivered, with or without mention of antepartum condition • ‘2’ Delivered, with mention of postpartum complication • ‘3’ Antepartum condition or complication • ‘4’ Postpartum condition or complication • ‘9’ Unspecified as to episode of care

  5. 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

  6. 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 physician • O48.001 Prolonged pregnancy, delivered, with or without mention of antepartum condition

  7. Trimesters • First trimester < 13th week • Second trimester 14th week—up to an including 26th week • Third trimester > 26 week gestation

  8. 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

  9. 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 • Begins at birth of infant • Ends as 42 days after birth of infant

  10. 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

  11. Pregnancy with abortive outcome Types: • Medical • Ectopic & Molar • Missed • Spontaneous • Failed Attempt

  12. 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)

  13. Missed or Spontaneous Abortion • Missed abortion • Early fetal death before completion of 20 weeks gestation with retention of dead fetus • Excludes mole: hydatidiform (O01.-) and nonhydatidiform (O02.0) • Spontaneous abortion • Miscarriage (premature expulsion of fetus that occurs naturally and without cause)

  14. 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

  15. 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

  16. Ruptured tubal pregnancy with shock (initial episode of care) • O00.1 (M) Tubal pregnancy • O08.3 (2) Shock following abortion/ectopic/molar pregnancy

  17. 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

  18. 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

  19. 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.

  20. 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

  21. Delivery in a completely normal case • (M) Z37.0 Outcome of delivery, single live birth • 5.MD.50.~ ~ Manually assisted vaginal delivery (vertex)

  22. 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

  23. 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 indication

  24. Delivery • 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

  25. Folio lookup Pregnancy • – – amnionitis O41.19 • – – anemia (conditions in D50 D64) O99.0 • – – 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

  26. Pregnancy • -conditions in • – – – B50 B64, O98.6 • – – – D50 D64, O99.0 • – – – D65 D89, O99.1 • – – – E40 E46, O25 • – – – F00 F99, O99.3

  27. Delivery • ‘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

  28. 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

  29. Induction and Augmentation of Labour • 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 labour • Mandatory to code

  30. 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

  31. 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

  32. 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

  33. Exclusion/Inclusion notes • O32.1 Maternal care for breech presentation • Excludes: the listed conditions with obstructed labour (O64.-) • O64.1 Obstructed labour due to breech presentation ++

  34. 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 Labour

  35. Newborn • Code Z38.0~ for every newborn • Z38.00 Singleton, born in hospital, delivered vaginally • Z38.01 Singleton, born in hospital, delivered by caesarean • Z38.1 Singleton, born outside hospital • Z38.2 Singleton, unspecified as to place of birth

  36. Diagnosis type 0 • If there is another contra-indication, Z38.0~ must still be coded but as a diagnosis type 0 • No diagnosis type 3 is allowed for newborn coding • Capture Z38 to distinguish babies born via caesarean section from those born vaginally.

  37. 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.

  38. P07.1 (M) Other low birth weight • P07.3 (1) Other preterm infant • Z38.01 (0) Singleton, born in hospital, delivered by cesarean section

  39. Low Birth Weight • WHO guidelines state that priority of assignment should be given to birth weight. • Birth weight of less than 2500 grams

  40. 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…

  41. Standard for P22.0 • P22.0 Respiratory Distress Syndrome • code when Surfactant is administered and diagnosis is documented as either RDS or TTN. • Code when baby transferred to higher-level nursery or dies before Surfactant can be administered.

  42. Terminology • 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

  43. Classification based on MRDx • MCC 14 Pregnancy and Childbirth • Factors that impact CMG Assignment • Complicating Cesarean Section • Previous Cesarean Sections • CMGs 600 - 624

  44. Classification based on MRDx • MCC 15 Newborns and Neonates with Conditions originating in the perinatal period • No complexity is assigned (level 9) • Weight impacts CGM Assignment • CMGs 625 - 648

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