As physicians continue the transition to ICD-10, there are several pregnancy complication documentation and coding issues that need to be addressed. Codes for reporting pregnancy complications, childbirth, and the puerperium are located in chapter 15 of ICD-10-CM and start with the letter ‘O’. According to a recent article from Medical Economics, some of the biggest changes for ICD-10 are including the trimester in which the condition occurs, and adding seventh digits to identify the fetus affected.
For pregnancy complications, the trimester in which the complication occurs is part of the code selection in ICD-10-CM. This trimester should be documented based on the number of weeks the patient has been pregnant. In ICD-10-CM, there is no longer a fifth digit classification for episode of care. The trimester is included as part of the complete code description. Instructions also state that an additional code from category Z3A Weeks of gestation needs to be assigned in order to identify the specific week of the pregnancy. This is used only on the maternal record.
For some complications of pregnancy codes, seventh character extensions that identify the fetus affected are required in order to complete a valid, reportable code. The seventh character ‘0’ is for single gestations and multiple gestations where the fetus affected is not specified. The seventh characters 1 to 9 are for cases of multiple gestations to identify the fetus for which the code applies. Coding instructions may also require that a code from category O30 Multiple gestation be used when reporting a code with a seventh digit.
In ICD-9-CM coding, diabetes mellitus (DM) complicating pregnancy, childbirth, or the puerperium is reported with 648.0x, and gestational diabetes is reported with 648.8x Abnormal glucose tolerance. Each of these forms of diabetes requires a fifth digit of 0-4 for the episode of care. For ICD-10-CM, DM in pregnancy, childbirth, and the puerperium, category O24, has been divided into six subcategories, each with further classified codes for a valid report. These subcategories include:
- Pre-existing DM, type 1
- Pre-existing DM, type 2
- Unspecified pre-existing DM
- Gestational DM
- Other pre-existing DM
- Unspecified DM
Each of these classifications provides codes identifying the trimester of pregnancy, childbirth, and the puerperium. In order to further specify the manifestations, additional codes are required for both ICD-9-CM and ICD-10-CM.
Unspecified pre-existing DM (O24.3-) is reported when the patient was diagnosed with diabetes before becoming pregnant. However, the type is not specified. Additional diabetes codes reported from the endocrine chapter used to identify the particular manifestations must be selected from category E11 for type 2 as the default. Unspecified DM (O24.9-) is reported when it is not known whether the diabetes is a pre-existing condition or a result of pregnancy.
Other pre-existing DM (O24.8-) is used when the patient had either diabetes mellitus due to an underlying condition, such as Cushing’s syndrome, or due to drugs, chemicals, genetic disorders, defects, or other secondary DM before becoming pregnant. Additional codes reported with O24.8- for the particular diabetic manifestations must be chosen from the category in the endocrine chapter that reflects the appropriate type of pre-existing diabetes. These will be from category E08, E09 or E13.
Gestational diabetes codes in ICD-10-CM have a marginally different structure than that of the pre-existing or unspecified DM in pregnancy codes. Gestational diabetes is subdivided into codes that specify whether it is diet controlled, insulin controlled, or unspecified controlled during pregnancy.
Author: Lauren Daniels