. In ICD-9 CM codes can be found in Chapter 11 Complications of Pregnancy, Childbirth and the Puerperium (630-679). Any conditions which occur during or affect the pregnancy and puerperium periods MUST be preceded by a code from this chapter with the use of additional codes from other chapters to further described the condition when needed. ICD-10 CM codes can be found in Chapter 15 Pregnancy, Childbirth and the Puerperium (O00-O9A).

1. Pregnancy (time of conception to delivery), Childbirth (delivery) and Puerperium (post-delivery thru six weeks) coding deals with conditions associated with these time periods. In ICD-9 CM codes can be found in Chapter 11 Complications of Pregnancy, Childbirth and the Puerperium (630-679). Any conditions which occur during or affect the pregnancy and puerperium periods MUST be preceded by a code from this chapter with the use of additional codes from other chapters to further described the condition when needed. ICD-10 CM codes can be found in Chapter 15 Pregnancy, Childbirth and the Puerperium (O00- O9A). Unlike ICD-9 CM, conditions which occur during or affect the puerperium period may be found in other chapters, for example: mental and behavioral disorders associated with the puerperium (F53); postpartum necrosis of pituitary gland (E23.0) and puerperal osteomalacia (M83.0). Chapter divisions are as follow:
ICD-9 CM ICD-10 CM
Ectopic & Molar Pregnancy (630-633) Pregnancy w/Abortive Outcome (O00-O08)
Hydatiform Mole (630) Ectopic & molar pregnancies are found in this
Other POC (631) subcategory along with any complications that
Missed Abortion (632) may result from the abortion; ectopic and/or
Ectopic Pregnancy (633) molar pregnancy.
Pregnancy with Abortive Outcome (634-639) Supervision of High-Risk Pregnancy (O09)
Spontaneous Abortion (634) Edema, Proteinuria &Hypertension (O10-O16)
Legally Induced (635) Other Maternal Disorders (O20-O29)
Illegally Induced (636) Related to Fetus, Amniotic Cavity & Possible
Unspecified (637) Delivery Problems (O30-O48)
Failed (638) Multiple gestational complications are found in
Complications (639) this subcategory.
Complications related to Pregnancy (640-649) Complications of Labor & Delivery (O60-O77)
Hemorrhage (640-641) Encounter for Delivery (O80-O82)
Hypertension (642) Complications related to Puerperium (O85-O92)
Vomiting (643) Other Obstetric Conditions, NEC (O94-O9A)
Early/Threatened, Late (644-645)
Other Complications & Other Conditions (646-649)
Delivery and other Indications of Care (650-659)
Complications during Labor/Delivery (660-669)
Complications of the Puerperium (670-677)
Other Maternal & Fetal Complications (678-679)
Pregnancy codes should be sequenced first over all other codes.
Pregnancy codes are only used on the mother’s record.
The physician decides if the pregnancy is “incidental” to the episode of care.
Use Outcome of Delivery codes for any type of delivery (live or stillbirth).
PREGNANCY, CHILDBIRTH & PUERPERIUM
WHAT TO EXPECT
1 Pregnancy, Childbirth & Puerperium
2 Helpful Information
3 Facts You Should Know
4 Requests for Coding Topics
November 2014
Volume 1 Issue 11
By Cynthia Brown, MBA, RHIT, CCS
www.cyntcodinghealthinformationservices.com
CCHIS, P.O. Box 3019, Decatur, GA 30031 404-992-8984
http://www.cyntcodinghealthinformationservices.com
Cynthia@cyntcodinghealthinformationservices.com [phone]
CODING YESTERDAY’S NOMENCLATURE TODAY®
PREGNANCY, CHILDBIRTH, & PUERPERIUM, PART 1
CODING NEWSLETTER FOR HEALTHCARE CODING PROFESSIONALS

2. Page 2 Coding Yesterday’s Nomenclature Today
TRIMESTERS (Used in ICD-10 CM):
1ST Trimester=less than 14 weeks 0 days
2nd Trimester=14 weeks 0 days to less than 28 weeks 0 days
3rd Trimester=28 weeks 0 days until delivery
GESTATIONAL AGE (Used in ICD-10 CM to specify week of the pregnancy):
Z3A.0=Unspecified or less than 10 weeks
Z3A.1=Weeks 10-19
Z3A.2=Weeks 20-29
Z3A.3=Weeks 30-39
Z3A.4=Weeks 40 or greater
OUTCOME OF DELIVERY (ICD-9 CM & ICD-10 CM):
V27.0=Single Live Birth Z37.0=Single Live Birth
V27.1=Single Stillbirth Z37.1=Single Stillbirth
V27.2=Twins, both live born Z37.2=Twins, both live born
V27.3=Twins, one live & one stillborn Z37.3=Twins, one live & one stillborn
V27.4=Twins, both Stillborn Z37.4=Twins, both Stillborn
V27.5=Other Multiple births, all live born Z37.5=Other Multiple births, all live born
V27.6=Other Multiple birth, some live born Z37.6=Other Multiple births, some live born
V27.7=Other Multiple birth, all stillborn Z37.7=Other Multiple births, all stillborn
V27.9=Unspecified outcome of delivery Z37.9=Outcome of Delivery, Unspecified
EPISODE OF CARE (Used in ICD-9 CM):
0=Unspecified as to episode of care or not applicable
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
The “episode of care” in ICD-9 CM has been replaced by the trimester in which the condition occurred.
“Fetal Growth”
The trimester and gestational age are not captured in ICD-9 CM.
HELPFUL INFORMATION

3. Coding Yesterday’s Nomenclature Today
FACTS YOU SHOULD KNOW
Codes V22.2 (ICD-9 CM) and Z33.1 (ICD-10 CM) should be used when the physician documents that the pregnancy is “incidental” to the presenting condition. Only the physician can make this distinction.
In ICD-10 CM when a code has an “in childbirth” condition and a delivery has occurred then the “in birth” code should be assigned. This is equivalent to the “episode of care” 5th digit “1” in ICD-9 CM. An example would be O24.12 Pre-existing Diabetes Mellitus, Type 2, in Childbirth. Pre-existing conditions are identified in the code description in ICD-10 CM (see O99.03) and by the 5th digit “3” in ICD-9 CM (see 648.23). Also, in ICD-9 CM the coder may have to use an additional code to completely identify the condition.
In ICD-9 CM, an elective abortion without complications is found under the abortion subcategory of Chapter 11; whereas, in ICD-10 CM Z33.2 is found in Chapter 21 Factors influencing Health Status and Contact with Health Services (Z00-Z99).
A change in the timeframe of early and late excessive vomiting during pregnancy is seen between ICD-9 CM and ICD-10 CM. In ICD-9 CM (643) early is considered before 22 weeks and late is after 22 weeks. In ICD-10 CM (O21) early (hyperemesis) is before 20 weeks and late is after 20 weeks.
Early hemorrhage during pregnancy for ICD-9 CM (640) is before 22 weeks gestation and ICD-10 CM (O20) is before 20 weeks of gestation.
Since trimesters are a part of the code makeup in ICD-10 CM, the coder should assign the trimester character for the trimester at the time of admission or encounter. Some codes do not include the trimester distinction as a part of the code because the condition may only occur in a specific trimester and therefore the distinction is not needed.
In ICD-10 CM some codes (O31, O32, O33.3-O33.6, O35, O36, O40, O41, O60.1, O60.2, O64 and O69) have a 7th character which identifies the fetus in multiple gestations affected by the condition. This is not the case in ICD-9 CM.
Supervision of High-risk Pregnancy is found in the Supplementary Classification of Factors Influencing Health Status & Contact with Health Services (V01-V91) chapter in ICD-9 CM (V23); but in ICD-10 CM (O09) has been moved to Chapter 15 Pregnancy, Childbirth & Puerperium.
Outcome of delivery codes should ALWAYS be used when a delivery occurs in ICD-9 CM (V27.0-V27.9) and ICD-10 CM (Z37.0- Z37.9).
REMEMBER: Do not use pregnancy-related codes on the newborn chart and do not use newborn-related codes on the mother’s chart for either nomenclature. Pregnancy codes have precedence over all other codes in both nomenclatures. The physician makes the determination of whether the pregnancy is affected by a condition.
AHIMA approved ICD-10 CM/PCS Trainer
ALL THINGS CODING®
“Accurate and complete coding is a must in today’s economically challenged healthcare environment.”

4. Page 4 Coding Yesterday’s Nomenclature Today
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