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With the release of the FY 2017 updates to the ICD-10-CM Official Coding Guidelines, there’s a lot for coding professionals to review. This post will take a closer look at one of the updates in Chapter 15: Pregnancy, Childbirth, and the Puerperium (O00-O9A). 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.
The FY2017 revised ICD-10-CM Guideline I.C.15.b.2. Supervision of High-Risk Pregnancy states:
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 may be used in conjunction with these codes if appropriate.
Some examples of code selections from the O09.5 section include:
-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
Now let’s take a look at coding an example scenario. For the purposes of this scenario, let’s say the patient was admitted to the hospital at 38 and 2/7 weeks gestation. The patient had noticed a lack of fetal movement over the past day or two and a non-stress test that was reactive. She is 38 years old and G6P3A2. She has had a previous C-section. Because of the decreased fetal movement, a repeat low cervical C-section was performed.
In this scenario, utilizing the new supervision of high-risk pregnancy guideline effective October 1, 2016, the patient is an elderly multigravida that delivered so we will NOT code O09.523, because she presents for delivery and these codes are not for use on a delivery admission.
According to the guidelines, the code in category O09 applies for certain situations where the patient is above or below a certain age because it can be a risk factor, potentially necessitating additional testing and monitoring for the development of complications. These circumstances necessitate the additional code to specify for monitoring during high-risk pregnancy. But the patient’s age by itself has no impact on the delivery episode. If the patient developed a complication as a result of her age, the complication would be coded.
Please keep this supervision of high-risk pregnancy guideline update in mind as you begin using the FY2017ICD-10-CM Guidelines for Coding and Reporting on discharges and dates of service beginning October 1, 2016. You will no longer be able to capture the history of infertility, history of ectopic or molar pregnancy, poor reproductive or obstetric history, insufficient antenatal care, grand multiparity, elderly primigravida and multigravida, young primigravida and multigravida, and/or high risk pregnancy due to social problems or other and unspecified high-risks on a delivery admission.
Some additional ICD-10 resources that are available for your review include:
- CMS website for ICD-10-CM and ICD-10-PCS files and updates: https://www.cms.gov/Medicare/Coding/ICD10/index.html
- Coordination and Maintenance Committee Meetings: https://www.cms.gov/Medicare/Coding/ICD9ProviderDiagnosticCodes/ICD-9-CM-C-and-M-Meeting-Materials.html
- CDC Coordination and Maintenance ICD-10-CM Resources: http://www.cdc.gov/nchs/icd/icd10cm_maintenance.htm
These 2017 ICD-10-CM and ICD-10-PCS codes are to be used for discharges occurring from October 1, 2016 through September 30, 2017 and for patient encounters occurring from October 1, 2016 through September 30, 2017.