The TrustHCS education team provides regular in-service coding tips to our team of credentialed coding professionals. This month, obstetrical procedures were highlighted. Compiling coding clinic information and various guidelines, the following covers the tips provided to the TrustHCS team.

 

General Reminders

The following are good reminders when coding obstetric procedures.

  1. Obstetric section (1) is utilized for procedures performed on the products of conception
  2. Medical and Surgical Section (0) is utilized for procedures performed on the pregnant female other than the products of conception are coded to the appropriate root operation (example:  cholecystectomy)
  3. Obstetric section is utilized for curettage of the endometrium with the root operation Extraction and body part Products of Conception, Retained
  4. Obstetric section is utilized for evacuation of retained products of conception with the root operation Extraction and body part Products of Conception, Retained
  5. When baby is delivered outside of hospital and patient presents to hospital and the placenta is delivered this is coded as delivery of products of conception since ICD-10-PCS does not differentiate between delivery of the baby and the placenta
  6. Vacuum assistance during cesarean section is not coded separately
  7. Code to the deepest layer when more than one location is documented to have an obstetric tear
  8. Repair of second-degree perineal laceration occurring during vaginal delivery is coded as open approach since the laceration has cut through the external body layers exposing muscle (based on the definition of second-degree perineal laceration)
  9. Peri-urethral laceration repair is coded as repair of vulva since peri-urethral is vulvar tissue
  10. Pitocin administration given to induce labor should be coded separately
  11. Pitocin administration given to augment active labor is NOT coded separately

 

Root Operation “Delivery”

When applying the root operation “Delivery” to obstetric charts, the following are additional items to keep top-of-mind as a coding professional.

  1. The root operation applies only to manually assisted vaginal delivery of the products of conception.
  2. Products of conception may be a full-term viable fetus or nonviable products of the conception.

 

Root Operation “Extraction”

When applying the root operation “Extraction”, note the following in your coding process.

  1. The root operation applies to cesarean deliveries and to vaginal deliveries utilizing forceps, vacuum or internal version
  2. Cesarean deliveries are reported with the approach value of open (0) and requires a qualifier value that identifies the type.
    • Classical (0)
    • Low Cervical (1)
    • Extraperitoneal (2))
  3. Vaginal extractions are reported with the approach value of Via Natural or Artificial Opening (7) and requires a qualifier value that identifies the type of assisted vaginal delivery.
    • Low Forceps (3)
    • Mid Forceps (4)
    • High Forceps (5)
    • Vacuum (6)
    • Internal Version (7)
    • Other (8)

 

Obstetric Procedure Reference Sheet

Type of Delivery ICD-10-PCS Code
Manually Assisted Delivery 10E0XZZ Delivery of Products of Conception, External Approach
Vacuum Extraction Delivery 10D07Z6 Extraction of Products of Conception, Vacuum, Via Natural or Artificial Opening
Low Forceps Delivery 10D07Z3 Extraction of Products of Conception, Low Forceps, Via Natural or Artificial Opening
Low Transverse or Low Cervical Cesarean Delivery 10D00Z1 Extraction of Products of Conception, Low, Open Approach
Other Procedures ICD-10-PCS Codes
Artificial Rupture of Membranes 10907ZC Drainage of Amniotic Fluid, Therapeutic from Products of Conception, Via Opening
Pitocin (oxytocin) 3E033VJ Introduction of Other Hormone into Peripheral Vein, Percutaneous Approach
Cervidil (prostaglandin gel insert) 3E0P7GC Introduce of Other Therapeutic Substance into Female Reproductive, Via Opening
Rotation 10S07ZZ Reposition Products of Conception, Via Natural or Artificial Opening
Routine Episiotomy (repair not coded because it is routine to procedure) 0W8NXZZ Division of Female Perineum, External Approach
Laceration Repair 0HQ9XZZ Repair Perineum Skin, External Approach – for repair 1st degree

0KQM0ZZ Repair Perineum Muscle, Open Approach – for repair 2nd degree

0DQR0ZZ Repair Anal Sphincter, Open Approach – for repair 3rd degree

0DQP0ZZ Repair Rectum, Open Approach – for repair 4th degree

0UQMXZZ Repair Vulva, External Approach

 

References
ICD-10-CM/PCS Coding Clinic®, Fourth Quarter 2018 Page: 49-51
ICD-10-CM/PCS Coding Clinic®, Fourth Quarter 2013 Page: 120
ICD-10-CM/PCS Coding Clinic®, Second Quarter 2014 Page: 9
ICD-10-CM/PCS Coding Clinic®, Fourth Quarter 2014 Pages: 17-19 and 43-44
ICD-10-CM/PCS Coding Clinic®, Third Quarter 2017 Page: 5
ICD-10-CM/PCS Coding Clinic®, Second Quarter 2016 Page: 33-34
ICD-10-CM/PCS Coding Clinic®, First Quarter 2016 Page: 8
ICD-10-PCS Official Guidelines for Coding and Reporting FY 2019