Coding Common Pregnancy Complications by Traci Vela

 

While there are many different pregnancy complications that may occur during each pregnancy, the same woman may or may not deal with each one in subsequent pregnancies. Like each new baby, pregnancy is unique. A woman may deal with several during one pregnancy, all, or none during others and still different complications in future pregnancies. Here are two of the more common pregnancy complications, including treatment and symptoms, and their respective appropriate ICD-10 codes.

 

  1. Gestational Diabetes

Some women develop a form of diabetes during pregnancy, known as gestational diabetes, which often resolves itself following delivery and is usually treated by diet and exercise changes during pregnancy. Insulin treatment is required in rare cases. For most women and pregnancies, gestational diabetes is discovered during the second trimester.

Keep in mind that separate, additional codes are required for those women who have diabetes mellitus as a preexisting condition prior to pregnancy.

Women who experience gestational diabetes have an increased risk of developing type 2 diabetes later in life, so they are usually advised to follow the same diet and exercise regimen as prediabetic patients.

Codes:[1]

O24.4: Gestational diabetes mellitus

  • 41: Gestational diabetes mellitus in pregnancy
    • 410: …… diet controlled
    • 414: …… insulin controlled
    • 415: …… controlled by oral hypoglycemic drugs
    • 419: …… unspecified control
  • 42: Gestational diabetes mellitus in childbirth
    • 420: …… diet controlled
    • 424: …… insulin controlled
    • 425: …… controlled by oral hypoglycemic drugs
    • 429: …… unspecified control
  • 43: Gestational diabetes mellitus in the puerperium
    • 430: …… diet controlled
    • 434: …… insulin controlled
    • 435: …… controlled by oral hypoglycemic drugs
    • 439: …… unspecified control

 

  1. Preterm Labor

Preterm labor is usually defined by the American College of Obstetrics and Gynecology as “Regular contractions of the uterus resulting in changes in the cervix that start before 37 weeks of pregnancy. Changes in the cervix include effacement (the cervix thins out) and dilation (the cervix opens so that the fetus can enter the birth canal).”[2] It can be further explained as labor occurring before the fetus is viable, or able to survive without extensive medical intervention. In the majority of cases, babies born before the 37th week, but after the 24th week, are able to be saved, but may require extensive treatment, lengthy hospital stay, and/or specialized care.[3]

Common symptoms of preterm labor include backache and cramping, but may also include vaginal bleeding, breaking of water (rare), or no symptoms at all.

Tocolysis, also called postponement of preterm labor, makes a reasonable attempt to halt or prevent premature labor and sometimes averts the birth of premature infants (infant, premature). Other common treatments are bed rest and medication, or hospitalization in more serious cases.

Codes[4]:

O60: Preterm labor

  • 0: Preterm labor without delivery
    • 00: …… unspecified trimester
    • 02: …… second trimester
    • 03: …… third trimester
  • 1: Preterm labor with preterm delivery
    • 10: Preterm labor with preterm delivery, unspecified trimester
      • 10X0: …… not applicable or unspecified
      • 10X1: …… fetus 1
      • 10X2: …… fetus 2
      • 10X3: …… fetus 3
      • 10X4: …… fetus 4
      • 10X5: …… fetus 5
      • 10X9: …… other fetus
    • 12: Preterm labor second trimester with preterm delivery second trimester
      • 12X0: …… not applicable or unspecified
      • 12X1: …… fetus 1
      • 12X2: …… fetus 2
      • 12X3: …… fetus 3
      • 12X4: …… fetus 4
      • 12X5: …… fetus 5
      • 12X9: …… other fetus
    • 13: Preterm labor second trimester with preterm delivery third trimester
      • 13X0: …… not applicable or unspecified
      • 13X1: …… fetus 1
      • 13X2: …… fetus 2
      • 13X3: …… fetus 3
      • 13X4: …… fetus 4
      • 13X5: …… fetus 5
      • 13X9: …… other fetus
    • 14: Preterm labor third trimester with preterm delivery third trimester
      • 14X0: …… not applicable or unspecified
      • 14X1: …… fetus 1
      • 14X2: …… fetus 2
      • 14X3: …… fetus 3
      • 14X4: …… fetus 4
      • 14X5: …… fetus 5
      • 14X9: …… other fetus

 

There is a difference between preterm labor (labor prior to Week 37) and full-term delivery (delivery around Week 39) with preterm labor. For the second, the patient has had symptoms/signs of early labor, but the baby was not delivered until the baby was considered “full-term.” Here are the appropriate codes to use in this situation:

  • 2: Term delivery with preterm labor
    • 20: Term delivery with preterm labor, unspecified trimester
      • 20X0: …… not applicable or unspecified
      • 20X1: …… fetus 1
      • 20X2: …… fetus 2
      • 20X3: …… fetus 3
      • 20X4: …… fetus 4
      • 20X5: …… fetus 5
      • 20X9: …… other fetus
    • 22: Term delivery with preterm labor, second trimester
      • 22X0: …… not applicable or unspecified
      • 22X1: …… fetus 1
      • 22X2: …… fetus 2
      • 22X3: …… fetus 3
      • 22X4: …… fetus 4
      • 22X5: …… fetus 5
      • 22X9: …… other fetus
    • 23: Term delivery with preterm labor, third trimester
      • 23X0: …… not applicable or unspecified
      • 23X1: …… fetus 1
      • 23X2: …… fetus 2
      • 23X3: …… fetus 3
      • 23X4: …… fetus 4
      • 23X5: …… fetus 5
      • 23X9: …… other fetus

 

[1] http://www.icd10data.com/ICD10CM/Codes/O00-O9A/O20-O29/O24-/O24.4

[2] https://www.acog.org/Patients/FAQs/Preterm-Premature-Labor-and-Birth#what

[3] http://pediatrics.aappublications.org/content/125/4/696?sso=1&sso_redirect_count=1&nfstatus=401&nftoken=00000000-0000-0000-0000-000000000000&nfstatusdescription=ERROR%3a+No+local+token

[4] http://www.icd10data.com/ICD10CM/Codes/O00-O9A/O60-O77/O60-