NTSV: Accurate Coding For Improved Quality Measures

NTSV: Accurate Coding forImproved Quality MeasuresProgram II: OB Diagnostic CodingModule 4: Conditions affecting pregnancy vs.conditions complicating delivery

Grant AcknowledgementFunding for this training series was made possible by a subaward from the American College of Obstetricians andGynecologists under Grant #UC4MC28042 from the HealthResources and Services Administration.The views expressed in the written materials and byspeakers and moderators do not necessarily reflect theofficial policies of the Department of Health and HumanServices nor does mention of trade names, commercialpractices, or organizations imply endorsement by the U.S.Government.

Resource AcknowledgementInformation presented in this module is directly resourcedfrom the 2020 ICD-10-CM/PCS Official Guidelines for Codingand Reporting found on the Centers for Disease Control andPrevention website and the ICD-10-CM and ICD-10-PCSCoding Handbook With Answers published by the AmericanHospital Association.

Our FacultyCarole Liebner, RHIT, CDIP, CCSAHIMA APPROVED ICD-10-CM/PCS TRAINERAHIMA APPROVED REVENUE CYCLE TRAINERDirector, Education & Program DevelopmentAmber Owens, RHIA, CICA, CCSDirector of Health Information Services

Program II: Module 4 Topics Review conditions affecting pregnancy vs. those complicatingdelivery. Discuss sequencing rules of Chapter 15 codes. Take a look at HIV and pregnancy. Revisit the diagnoses from other chapters that affectpregnancy. Recap the social determinants of health and pregnancy. And a little assessment at the end to test your knowledge.

Sequencing Obstetric cases require codes from chapter 15, codes in therange O00-O9A, Pregnancy, Childbirth, and the Puerperium.Chapter 15 codes have sequencing priority over codes fromother chapters. It is the provider’s responsibility to state that the conditionbeing treated is not affecting the pregnancy. Additional codes from other chapters may be used with chapter 15 codesfor more specificity of a condition.If the provider documents that the pregnancy is incidental to theencounter, then use code Z33.1, Pregnant state, incidental, instead ofany chapter 15 codes.Chapter 15 codes are to be used only on the maternal record,never on the record of the newborn.

HIV and Pregnancy Always assign subcategory O98.7 to identify humanimmunodeficiency (HIV) disease complicating pregnancy,childbirth and the puerperium: Ifthe patient has an associated HIV-related illnessassign the appropriate codes for those conditions afterthe O98.7- code. Ifthe patient is asymptomatic, assign codes O98.7- andZ21, Asymptomatic human immunodeficiency virus(HIV) infection.

Conditions Complicating Pregnancy,Childbirth, and the Puerperium Category O99 describes othermaternal diseases classifiableelsewhere. Includes: O99.0: AnemiaO99.1: Other diseases of the bloodand blood-forming organs andcertain disorders involving theimmune mechanismO99.2: Endocrine, nutritional, andmetabolic diseasesO99.3: Mental disorders anddiseases of the nervous system O99.4: Diseases of thecirculatory system O99.5: Diseases of therespiratory system O99.6: Diseases of thedigestive system O99.7: Diseases of the skinand subcutaneous tissue O99.8: Other specifieddiseases and conditions

Anemia O99.0: Anemia TheO99.0- code will be assigned when the anemia is apre-existing condition and would usually be classifiedin the D50-D64 range. TheD code would also be assigned here to show thespecificity of the anemia. Donot confuse this with anemia due to the pregnancyor post-partum anemia that was not present prior todelivery.

Blood and Blood-forming Organs and theImmune Mechanism O99.1: Other diseases of the blood and blood-forming organsand certain disorders involving the immune mechanism The O99.1- code will be assigned when the condition is a pre-existingcondition and would usually be classified in the D65-D89 range. The D code would also be assigned here to show the specificity of thecondition. These codes do not include a hemorrhage with coagulation defects.

Endocrine, Nutritional, and MetabolicDiseases O99.2: Endocrine, nutritional, and metabolic diseases The O99.2- code will be assigned when the condition is a pre-existingcondition and would usually be classified in the E00-E88 range. The E code would also be assigned here to show the specificity of thecondition. Conditions for this category include: Obesity Metabolic disorders – such as hypothyroidismConditions not here: Diabetes Malnutrition

Mental Disorders and Nervous System O99.3: Mental disorders and diseases of the nervoussystem The O99.3- code will be assigned when the condition is apre-existing condition and would usually be classified in theF00 –G99 ranges. The F or G code would also be assigned here to show thespecificity of the condition.

Alcohol Use During Pregnancy, Childbirthand the Puerperium Codes under subcategory O99.31: Alcohol usecomplicating pregnancy, childbirth, and the puerperium,should be assigned for any pregnancy case when a motheruses alcohol during the pregnancy or postpartum. A secondary code from category F10, Alcohol relateddisorders, should also be assigned to identifymanifestations of the alcohol use, abuse or dependence.

Drug Use During Pregnancy, Childbirthand the Puerperium Codes under subcategory O99.32: Drug use complicatingpregnancy, childbirth, and the puerperium should beassigned for any pregnancy case when a mother uses drugsduring the pregnancy or postpartum. A secondary code from category F11 – F16, F18-F19Substance related disorders, should also be assigned toidentify manifestations of the substance use, abuse ordependence.

Tobacco Use During Pregnancy,Childbirth and the Puerperium Codes under subcategory O99.33: Smoking (tobacco)complicating pregnancy, childbirth, and the puerperium,should be assigned for any pregnancy case when a motheruses any type of tobacco product during the pregnancy orpostpartum. A secondary code from category F17, Nicotinedependence, should also be assigned to identify the typeof nicotine dependence.

Circulatory System O99.4: Diseases of the circulatory system The O99.4- code will be assigned when the condition is apre-existing condition and would usually be classified inthe I00 - I99 ranges. The I code would also be assigned here to show the specificity ofthe condition. Hypertensive Disorders (O10 - O16) would be coded elsewhere.

Cardiovascular Complications Assign code O90.3 when cardiomyopathy develops as aresult of pregnancy in women without pre-existing heartdisease. Assign code O99.4: Diseases of the circulatory systemcomplicating pregnancy, childbirth and the puerperium,for pre-existing heart disease complicating pregnancy.

Pregnancy-Associated Cardiomyopathy Pregnancy-associated cardiomyopathy, code O90.3, isunique in that it may be diagnosed in the third trimesterof pregnancy or up to five months postpartum, but maycontinue to progress months after delivery. This is a lifelong complication; for this reason, it isreferred to as peripartum cardiomyopathy (PPCM). Code O90.3 is only for use when the cardiomyopathydevelops as a result of pregnancy in a woman who did nothave pre-existing heart disease.

Respiratory System O99.5: Diseases of the respiratory system TheO99.5- code will be assigned when the condition isa pre-existing condition and would usually be classifiedin the J00 – J99 ranges. TheJ code would also be assigned here to show thespecificity of the condition. Example:Asthma/COPD

Digestive System O99.6: Diseases of the digestive system TheO99.6- code will be assigned when the condition isa pre-existing condition and would usually be classifiedin the K00 –K93 ranges. TheK code would also be assigned here to show thespecificity of the condition. Example:GERD/Cholecystitis

Skin and Subcutaneous Tissue O99.7: Diseases of the skin and subcutaneous tissue TheO99.7- code will be assigned when the condition isa pre-existing condition and would usually be classifiedin the L00 –L99 ranges. TheL code would also be assigned here to show thespecificity of the condition. Example:Cellulitis/Psoriasis

Other Specified O99.8: Other specified diseases and conditions TheO99.8- code will be assigned when the condition isa pre-existing condition and would usually be classifiedin conditions: D00-D48 H00-H95 M00-N99 Q00-Q99

Group B Strep In women, GBS most often is found in the vagina andrectum. GBS can pass from a pregnant woman to the fetus duringlabor. It happens to 1 – 2% of babies when the mother does notreceive treatment with antibiotics during labor. GBS screening is part of routine prenatal care. Screening is done between 36 and 38 weeks of pregnancy.

Group B Strep Positive If results show that GBS is present, most women willreceive antibiotics through IV antibiotics once labor hasstarted. Antibiotics help protect the fetus from being infected. The best time for treatment is during labor.

Group B Strep Coding Coding depends on active infection or carrier only. O99.824: Streptococcus B carrier state complicating childbirth,for maternal group B Streptococcus (GBS) carrier statuscomplicating childbirth O98.82: Other maternal infectious and parasitic diseasescomplicating childbirth, and B95.1: Streptococcus, group B, as thecause of diseases classified elsewhere, for maternal active GBSinfection complicating childbirth

Antibiotics without Testing Antibiotics may be given without testing if: Delivery of a previous child who had GBS disease. GBS bacteria in the urine at any point during the pregnancy. GBS status is unknown when in labor and a fever is present. GBS status is unknown and in labor before 37 weeks. GBS status is unknown and membranes have been ruptured forgreater than 18 hours. GBS status for this pregnancy is unknown but the mom waspositive for GBS in a past pregnancy.

COVID-19COVID-19 infection in pregnancy, childbirth, and thepuerperium. A patient presenting because of COVID-19 should receive a principaldiagnosis code of O98.5- : Other viral diseases complicatingpregnancy, childbirth and the puerperium. U07.1: COVID-19, and the appropriate codes for associatedmanifestation(s) are secondary diagnoses. Again, codes from Chapter 15 always take sequencing priority.

Malignant Neoplasms ComplicatingPregnancy Subcategory O9A.1, Malignant neoplasms complicatingpregnancy, childbirth, and the puerperium, classifiesmalignancy in pregnancy Assign also additional code(s) to identify the specific neoplasm(subcategories C00–C96). Maternal care for benign tumor of corpus uteri is coded toO34.1-. Maternal care for benign tumor of cervix is classified toO34.4-.

Injury, Poisoning and Certain OtherConsequences of External Causes A code from subcategory O9A.2, Injury, poisoning andcertain other consequences of external causescomplicating pregnancy, childbirth, and the puerperium,should be sequenced first, followed by the appropriateinjury, poisoning, toxic effect, adverse effect orunderdosing code, and then the additional code(s) thatspecifies the condition caused by the poisoning, toxiceffect, adverse effect or underdosing. Conditions in S00-T88, except T74 and T76.

Abuse in Pregnancy For suspected or confirmed cases of abuse of a pregnantpatient, a code(s) from subcategories: O9A.3: Physical abuse complicating pregnancy, childbirth,and the puerperium O9A.4: Sexual abuse complicating pregnancy, childbirth,and the puerperium O9A.5: Psychological abuse complicating pregnancy,childbirth, and the puerperium These codes should be sequenced first, followed by the appropriatecodes (if applicable) to identify any associated current injury due tophysical abuse, sexual abuse, and the perpetrator of abuse (Y07.-).