One of the most challenging areas for coders in medical coding and billing companies is obstetrics and gynecology medical billing and coding.
Effective October 1, 2016, the guideline for “Prenatal outpatient visits for high-risk patients” has been replaced with the title of “Supervision of High-Risk Pregnancy,” and includes additional guidance.
Chapter 15 of ICD-10-CM contains codes pertaining to Pregnancy, Childbirth and the Puerpernium (O00-O9A):
- O00-O08, Pregnancy with Abortive Outcome
- O09, Supervision of High Risk Pregnancy
- O10-O16, Edema, Proteinuria and Hypertensive Disorders in Pregnancy, Childbirth and the Puerperium
- O20-O29, Other Maternal Disorders Predominantly Related To Pregnancy
- O30-O48, Maternal Care Related To the Fetus and Amniotic Cavity and Possible Delivery Problems
- O60-O77, Complications of Labor and Delivery
- O80-O82, Encounter for Delivery
- O85-O92, Complications Predominantly Related To the Puerperium
- O94-O9A, Other Obstetric Conditions, Not Elsewhere Classified
Chapter 15 codes are to be used only on the maternal record and never on the newborn’s record.
Supervision of High-Risk Pregnancy
Coding high-risk pregnancy has changed in 2017. The rule from the 2017 ICD-10-CM Official Guidelines for Coding and Reporting (effective October 1, 2016) is:
Codes from category O09, Supervision of high-risk pregnancy, are intended for use only during the prenatal period. For complications during the labor or delivery episode as a result of a high-risk pregnancy, assign the applicable complication codes from Chapter 15. If there are no complications during the labor or delivery episode, assign code O80, Encounter for full-term uncomplicated delivery.
For routine prenatal outpatient visits for patients with high-risk pregnancies, a code from category O09, Supervision of high-risk pregnancy, should be used as the first-listed diagnosis. Secondary chapter 15 codes can be used in conjunction with these codes if appropriate.
A report from the American Health Information Management Association (AHIMA) provides the following examples of code selections from Section O09.5 section:
-O09.5 Supervision of elderly primigravida and multigravida (Pregnancy for a female 35 years and older at expected date of delivery)
-O09.51 Supervision of elderly primigravida
- 511 Supervision of elderly primigravida, first trimester
- 512 Supervision of elderly primigravida, second trimester
- 513 Supervision of elderly primigravida, third trimester
- 519 Supervision of elderly primigravida, unspecified trimester
-O09.52 Supervision of elderly multigravida
- 521 Supervision of elderly multigravida, first trimester
- 522 Supervision of elderly multigravida, second trimester
- 523 Supervision of elderly multigravida, third trimester
- 529 Supervision of elderly multigravida, unspecified trimester
When Codes from Category O09 Apply
According to the ICD-10 coding guidelines, codes from category O09, supervision of high risk pregnancy, is valid for certain circumstances where the patient is above or below a certain age because it can be a risk factor, potentially requiring additional testing and monitoring for the development of complications. In these situations, the use of the additional code is necessary to specify for monitoring during high-risk pregnancy. While the patient’s age by itself has no impact on the delivery episode, the complication would be coded if the patient developed a complication because of her age.
When a Code from Category O09 Should NOT be Used
AHIMA provides the following example of when a code from category O09 does NOT apply: a woman was admitted to the hospital at 38 and 2/7 weeks gestation. She had noticed lack of fetal movement over a couple of days and a non-stress test was normal (reactive). This 38-year-old Gravida 6, Para 3, Abortions 2 (G6P3A2) woman has had a previous C-section. The gynecologist performed a repeat low cervical C-section because of the decreased fetal movement, was performed.
In this scenario, based on the new supervision of high-risk pregnancy ICD-10 coding guideline effective October 1, 2016, code O09.523 will not be used as the patient is an elderly multigravida that delivered; she presents for delivery and these codes are not for use on a delivery admission.
ICD-10 Coding Guidelines 2017 – Other Points to Note
- Episodes when no delivery occurs: In episodes when no delivery occurs, the principal diagnosis should correspond to the principal complication of the pregnancy which necessitated the encounter. If more than one complication exists, all of which are treated or monitored, any of the complications codes may be sequenced first.
- When a delivery occurs: When an obstetric patient is admitted and delivers during that admission, the condition that prompted the admission should be sequenced as the principal diagnosis. If multiple conditions prompted the admission, the one most related to the delivery should be sequenced as the principal diagnosis. A code for any complication of the delivery should be assigned as an additional diagnosis. In cases of cesarean delivery, if the patient was admitted with a condition that resulted in the performance of a cesarean procedure, this condition should be selected as the principal diagnosis. If the reason for the admission was unrelated to the condition resulting in the cesarean delivery, the condition related to the reason for the admission should be selected as the principal diagnosis.
- Outcome of delivery: A code from category 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.
Risk Factors for a High-risk Pregnancy
A high-risk pregnancy is one that threatens the health or life of the mother or her fetus. In most cases, women who receive early and regular prenatal care have a healthy pregnancy and delivery without complications. However, due to various reasons, some women face an increased risk for complications even before they get pregnant. Examples of risk factors for a high-risk pregnancy include:
- Existing health conditions: For instance, having high blood pressure and/or diabetes, or being HIV-positive.
- Overweight and obesity: More than 50 percent of pregnant women in the U.S. are overweight or obese, according to the American Congress of Obstetricians and Gynecologists. Being obese raises the risk for high blood pressure, preeclampsia, gestational diabetes, stillbirth, neural tube defects, and cesarean delivery. Studies have found that maternal obesity can increase infants’ risk of heart problems at birth by 15 percent.
- Multiple births: Women more than one fetus (twins and higher-order multiples) face a higher risk of complications. Typical issues include preeclampsia, premature labor, and preterm birth.
- Young or old maternal age: The age of the mother is one of the common factors for high-risk pregnancy. Those who are in their teens or aged 35 or over have a higher risk for preeclampsia and gestational high blood pressure.
- Previous fetal loss: Previous fetal death poses a risk for subsequent pregnancy.
- History of complications with previous pregnancies: Complications experienced during a previous pregnancy are more likely to recur.
To ensure that their pregnancies are healthy and that they can carry their infant or infants to term, women with high-risk pregnancies should receive care from a special team of health care providers. Opting to outsource medical billing and coding is a feasible strategy for obstetrics and gynecology specialists. With an experienced team of AAPC-certified coders and billing professionals handling their coding and claim submission for appropriate reimbursement, these providers can focus on what they do best – providing the care that their patients need.
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