Documenting and Coding Abruptio Placentae in ICD-10

Abruptio placentae refer to the premature separation (abruption) of the placenta from the uterine lining before childbirth. Regarded as a serious complication of pregnancy, the condition generally occurs in the third trimester of the pregnancy but can also occur any time after the 20th week of pregnancy. The placenta is the organ that supplies food and oxygen to the baby during the pregnancy period. Also called placental abruption, abruptio placentae symptoms include vaginal bleeding and painful contractions. Blood and oxygen supply to the baby may also be affected, leading to fetal distress. Placental abruption often happens suddenly and if left untreated, it can be life-threatening both to the baby and the mother. Most cases of placenta disruption can be effectively treated depending on what type of separation occurs. Treatment for this condition depends on the severity of the condition and can range from bed rest to emergency C-section. Medical billing and coding tasks for this condition can be challenging. Relying on the services of a reliable obstetrics medical billing company can help obstetrics and gynecology practices manage the coding and billing for these services.

The exact cause of this condition is unknown, but problems like high blood pressure, chronic diabetes, habit of smoking and cocaine or alcohol use (during pregnancy period), multiple pregnancies, pregnancy in older mother, trauma or injury to the abdomen (from auto accident or fall) or rapid loss of amniotic fluid (that surrounds and cushions the baby in the uterus) can increase the potential risk of this condition.

Symptoms of Placenta Abruption
In most cases, the signs and symptoms occur during the last trimester of pregnancy, especially during the last few weeks before birth. However, each woman has different symptoms of placenta abruption. One of the most common symptoms is vaginal bleeding with pain during the third trimester of pregnancy. Other related symptoms include –

• • Abdominal pain
  • Vaginal bleeding
  • Uterine tenderness
  • Uterine contractions, often coming one right after another
  • Tender uterus
  • Firmness in the uterus or abdomen
  • Backache

It is important to note that some of the above listed symptoms can be quite similar to other conditions. Abdominal pain and back pain can often develop suddenly. The amount of bleeding can vary greatly and doesn’t necessarily correspond to how much placenta has separated from the uterus. Another possibility is that the blood may get trapped inside the uterus and so even with a severe placental abruption, there might be no visible signs of bleeding. On the other hand, in some cases, abruption of the placenta may occur slowly. Also called chronic abruption, this can cause light, intermittent vaginal bleeding. In such cases, the growth of the child may not occur as expected as the pregnant mother may have low amniotic fluid (oligohydramnios) or other complications.

How Is Placenta Abruption Diagnosed and Treated?

Generally, placenta abruption is diagnosed based on the symptoms, the amount of bleeding and pain. Physicians will also conduct a complete physical examination to check for uterine tenderness or rigidity. They may also recommend blood and urine tests to help identify the possible sources of vaginal bleeding and to check the fetus.

It is not possible to reattach a placenta that gets separated from the wall of the uterus. Treatment options depend on the severity of the separation, location of the separation and the duration of pregnancy. There can be both partial separation and total/complete separation that occurs. In case of partial separation, bed rest and close monitoring may be recommended by the gynecologist if the pregnancy has not reached maturity. On the other hand, transfusions and other emergency treatment may also be done. Delivery is not the safest course of action in case of total/complete separation. However, if the fetus is stable, vaginal delivery may be a preferred option. If the fetus is in distress or the mother is experiencing severe bleeding, then a cesarean delivery would be recommended. Any type of placental abruption can lead to premature birth and low birth weight.

Treating different types of placenta abruption is a formidable challenge for hospitals and practitioners. Obstetricians-gynecologists need to correctly diagnose the symptoms of placental abruption and report it using the correct codes. Medical billing outsourcing services provided by reputable medical billing companies can help physicians use the correct codes for their billing purposes.

The ICD-10 codes for Abruptio Placentae are as follows –

O45 – Premature separation of placenta [abruptio placentae]

• O45.0 – Premature separation of placenta with coagulation defect
  • O45.00 – Premature separation of placenta with coagulation defect, unspecified
    • O45.001 -Premature separation of placenta with coagulation defect, unspecified, first trimester
    • O45.002 – Premature separation of placenta with coagulation defect, unspecified, second trimester
    • O45.003 – Premature separation of placenta with coagulation defect, unspecified, third trimester
    • O45.009 – Premature separation of placenta with coagulation defect, unspecified, unspecified trimester

• • O45.01 – Premature separation of placenta with afibrinogenemia
    • O45.011 – Premature separation of placenta with afibrinogenemia, first trimester
    • O45.012 – Premature separation of placenta with afibrinogenemia, second trimester
    • O45.013 – Premature separation of placenta with afibrinogenemia, third trimester
    • O45.019 – Premature separation of placenta with afibrinogenemia, unspecified trimester

• • O45.02 – Premature separation of placenta with disseminated intravascular coagulation
    • O45.021 – Premature separation of placenta with disseminated intravascular coagulation, first trimester
    • O45.022 – Premature separation of placenta with disseminated intravascular coagulation, second trimester
    • O45.023 – Premature separation of placenta with disseminated intravascular coagulation, third trimester
    • O45.029 – Premature separation of placenta with disseminated intravascular coagulation, unspecified trimester

• • O45.09 – Premature separation of placenta with other coagulation defect
    • O45.091 -Premature separation of placenta with other coagulation defect, first trimester
    • O45.092 -Premature separation of placenta with other coagulation defect, second trimester
    • O45.093 -Premature separation of placenta with other coagulation defect, third trimester
    • O45.099 -Premature separation of placenta with other coagulation defect, unspecified trimester

• O45.8 – Other premature separation of placenta
  • O45.8X – Other premature separation of placenta
    • O45.8X1 Other premature separation of placenta, first trimester
    • O45.8X2 Other premature separation of placenta, second trimester
    • O45.8X3 Other premature separation of placenta, third trimester
    • O45.8X9 Other premature separation of placenta, unspecified trimester

• O45.9 – Premature separation of placenta, unspecified
  • O45.90 -Premature separation of placenta, unspecified, unspecified trimester
  • O45.91 -Premature separation of placenta, unspecified, first trimester
  • O45.92 -Premature separation of placenta, unspecified, second trimester
  • O45.93 -Premature separation of placenta, unspecified, third trimester

It is not possible to prevent placental abruption, but you can reduce the risk factors associated with condition. For instance, women should not attempt smoking or use illegal drugs (such as cocaine), during the pregnancy period. In addition, blood pressure levels should be correctly monitored. Always, wear seatbelt while travelling in a motor vehicle as this can reduce the amount of injury if you happen to experience an auto accident, fall or other injury.

Having a clear understanding about the ICD-10 codes related to documenting placental abruption is crucial for healthcare providers. For more efficient and reliable coding, physicians can consider partnering with outsourced medical billing companies, as experienced coders in such firms will be familiar with all the related codes and can assign the right codes.

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Natalie Tornese

Holding a CPC certification from the American Academy of Professional Coders (AAPC), Natalie is a seasoned professional actively managing medical billing, medical coding, verification, and authorization services at OSI.

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