ICD 10 Coding Alert

You’ll make a new distinction between ectopic and molar pregnancies.

In the ICD-10 Coding Alert volume 6 number 5 issue, you learned about the gynecological ICD-10 codes to expect October 1, 2016. Now, check out the obstetric changes heading your way, which include new codes Z31.7 (Encounter for procreative management and counseling for gestational carrier) and Z33.3 (Pregnant state, gestational carrier).

To get the full picture, look at these five new changes that will affect your obstetric practice.

1. Deleted Pregnancy Codes Each Become Two More Detailed Versions

You’ve got expanded options to replace the following deletions.

You’ll delete O00.0 (Abdominal pregnancy). Instead, you should add O00.00 (Abdominal pregnancy without intrauterine pregnancy) and O00.01 (Abdominal pregnancy with intrauterine pregnancy).

You will cross out O00.1 (Tubal pregnancy). You should add O00.10 (Tubal pregnancy without intrauterine pregnancy) and O00.11 (Tubal pregnancy with intrauterine pregnancy).

Get ready to erase O00.2 (Ovarian pregnancy) from your coding cache, and look to these options instead: O00.20 (Ovarian pregnancy without intrauterine pregnancy) and

O00.21 (Ovarian pregnancy with intrauterine pregnancy).

Forget O00.8 (Other ectopic pregnancy), because you will report O00.80 (Other ectopic pregnancy without intrauterine pregnancy) and O00.81 (Other ectopic pregnancy with intrauterine pregnancy) instead.

Similarly, you’ll delete O00.9 (Ectopic pregnancy, unspecified) and look to O00.90 (Unspecified ectopic pregnancy without intrauterine pregnancy) and O00.91 (Unspecified ectopic pregnancy with intrauterine pregnancy) instead.

“These changes are welcome as they represent the old ICD-9 terminology and because there was no way in ICD-10 to report an ectopic with an intrauterine pregnancy otherwise,” says Melanie Witt, RN, MA, independent ob-gyn consultant in Guadalupita, N.M. “This occurs more frequently in women who have had ovulation induction or assisted reproductive procedures.”

2. Don’t Overlook These Molar Revisions, Additions

Ectopic pregnancy conditions also get a descriptor revision. Codes O09.1- (Supervision of pregnancy with history of ectopic or molar pregnancy, …) will become (Supervision of pregnancy with history of ectopic pregnancy, …). The fifth digit will specify trimester.

If you notice, the revision removes the mention of molar pregnancy. That’s because molar pregnancies get their own codes:

• O09.A0 (Supervision of pregnancy with history of molar pregnancy, unspecified trimester)
• O09.A1 (Supervision of pregnancy with history of molar pregnancy, first trimester)
• O09.A2 (Supervision of pregnancy with history of molar pregnancy, second trimester)
• O09.A3 (Supervision of pregnancy with history of molar pregnancy, third trimester).

“These changes were made because an ectopic and molar pregnancy are totally distinct from one another and each requires different patient management. This should make it clear to payers that treatments are appropriate for the condition,” Witt says.

3. Untangle These Complication Codes

You need to examine complication codes, because you have more options from which to choose.

Get ready to use O11.4 (Pre-existing hypertension with pre-eclampsia, complicating childbirth) and O11.5 (Pre-existing hypertension with pre-eclampsia, complicating the puerperium).

You’ll have these new conditions:

• O12.04 (Gestational edema, complicating childbirth)
• O12.05 (Gestational edema, complicating the puerperium)
• O12.14 (Gestational proteinuria, complicating childbirth)
• O12.15 (Gestational proteinuria, complicating the puerperium)
• O12.24 (Gestational edema with proteinuria, complicating childbirth)
• O12.25 (Gestational edema with proteinuria, complicating the puerperium).

You’ll also have these options:

• O13.4 (Gestational [pregnancy-induced] hypertension without significant proteinuria, complicating childbirth)
• O13.5 (Gestational [pregnancy-induced] hypertension without significant proteinuria, complicating the puerperium).

Your O14 codes will expand to include:

• O14.04 (Mild to moderate pre-eclampsia, complicating childbirth)
• O14.05 (Mild to moderate pre-eclampsia, complicating the puerperium)
• O14.14 (Severe pre-eclampsia complicating childbirth)
• O14.15 (Severe pre-eclampsia, complicating the puerperium)
• O14.24 (HELLP syndrome, complicating childbirth)
• O14.25 (HELLP syndrome, complicating the puerperium)
• O14.94 (Unspecified pre-eclampsia, complicating childbirth)
• O14.95 (Unspecified pre-eclampsia, complicating the puerperium).

You also have revisions, such as these eclampsia descriptors:

• O15.00 (Eclampsia in pregnancy, unspecified trimester) will become (Eclampsia complicating pregnancy, unspecified trimester).
• O15.02 (Eclampsia in pregnancy, second trimester) will become (Eclampsia complicating pregnancy, second trimester).
• O15.03 (Eclampsia in pregnancy, third trimester) will become (Eclampsia complicating pregnancy, third trimester).
• O15.1 (Eclampsia in labor) will become (Eclampsia complicating labor).
• O15.2 (Eclampsia in the puerperium) will become (Eclampsia complicating the puerperium).

Heads up: You will also add O16.4 (Unspecified maternal hypertension, complicating childbirth) and O16.5 (Unspecified maternal hypertension, complicating the puerperium).

4. Here’s How You’ll Overhaul Gestational Diabetes Dx

Expert advice: “The O24.0- and O24.1- changes represent only a more clinically correct description of both type 1 and type 2 diabetes; this change does not alter the use of these codes. However, the changes to the gestational diabetes codes bring us to the complete picture. Until now, we only had code for dietary and insulin control of gestational diabetes. In October, we will add control with hypoglycemic agents (such as Glyburide or Metformin),” Witt says. “These options for treatment are much more common. “

Important: The tabular index will also include a note to use an additional code to identify the type of control using new code Z79.84 (Long term [current] use of oral hypoglycemic drugs) with all type 2 diabetic codes. This means that if you are reporting either an E11 code (type 2 diabetes) or an O24.1- code, Z79.84 will need to be also reported if the patient is taking oral medication. This new code will not be reported with the gestational diabetes codes, since the new codes include this information. As a reminder, correct coding for a type 2 diabetic pregnant patient would require reporting O24.1-, an E11 code for manifestations, and either Z79.4 for insulin control or new code Z79.84 for hypoglycemic control.

Take note of the following revisions:

• O24.01- (Pre-existing diabetes mellitus, type 1, in pregnancy …) will become (Pre-existing type 1 diabetes mellitus, in pregnancy …) with the sixth digit specifying trimester.
• O24.02 (Pre-existing diabetes mellitus, type 1, in childbirth) will become (Pre-existing type 1 diabetes mellitus, in childbirth).
• O24.03 (Pre-existing diabetes mellitus, type 1, in the puerperium) will become (Pre-existing type 1 diabetes mellitus, in the puerperium).
• O24.11- (Pre-existing diabetes mellitus, type 2, in pregnancy, …) will become (Pre-existing type 2 diabetes mellitus, in pregnancy ….)
• O24.12 (Pre-existing diabetes mellitus, type 2, in childbirth) will become (Pre-existing type 2 diabetes mellitus, in childbirth).
• O24.13 (Pre-existing diabetes mellitus, type 2, in the puerperium) will become (Pre-existing type 2 diabetes mellitus, in the puerperium).

You’ve also got these new codes from which to choose:

• O24.415 (Gestational diabetes mellitus in pregnancy, controlled by oral hypoglycemic drugs)
• O24.425 (Gestational diabetes mellitus in childbirth, controlled by oral hypoglycemic drugs)
• O24.435 (Gestational diabetes mellitus in puerperium, controlled by oral hypoglycemic drugs).

5. Don’t Miss These Other Miscellaneous Codes

You will delete O33.7 (Maternal care for disproportion due to other fetal deformities), and then you will add the following expanded options:

• O33.7XX0 (Maternal care for disproportion due to other fetal deformities, not applicable or unspecified)
• O33.7XX1 (… fetus 1)
• O33.7XX2 (… fetus 2)
• O33.7XX3 (… fetus 3)
• O33.7XX4 (… fetus 4)
• O33.7XX5 (… fetus 5)
• O33.7XX9 (… other fetus).

You will also cross out O34.21 (Maternal care for scar from previous cesarean delivery) and add the following expanded options:

• O34.211 (Maternal care for low transverse scar from previous cesarean delivery)
• O34.212 (Maternal care for vertical scar from previous cesarean delivery)
• O34.219 (Maternal care for unspecified type scar from previous cesarean delivery).

You’ve got some more revisions to understand, as well:

• O44.0- (Placenta previa specified as without hemorrhage, …) will become (Complete placenta previa NOS or without hemorrhage …) with the fifth digit representing trimester.
• O44.1-   (Placenta previa with hemorrhage, …) will become (Complete placenta previa with hemorrhage, …) with the fifth digit representing trimester.

Additionally, you will add the following codes:

• O44.2- (Partial placenta previa NOS or without hemorrhage, …) with the fifth digit representing trimester.
• O44.3- (Partial placenta previa with hemorrhage, …) with the fifth digit representing trimester.
• O44.4- (Low lying placenta NOS or without hemorrhage, …) with the fifth digit representing trimester.
• O44.5- (Low lying placenta with hemorrhage, …) with the fifth digit representing trimester.

Clinically, a “complete” previa will mean that the internal cervical os is completely covered by the placenta. “Partial” indicates that the placenta only covers part of the cervical os.  “Low lying” means that the placenta implants low in the uterus but does not cover the cervix. Provider documentation will need to clearly make this distinction in order to code correctly, Witt says.

Finally, you will delete O70.2 (Third degree perineal laceration during delivery) and add these expanded options:

• O70.20 (Third degree perineal laceration during delivery, unspecified)
• O70.21 (Third degree perineal laceration during delivery, IIIa)
• O70.22 (Third degree perineal laceration during delivery, IIIb)
• O70.23 (Third degree perineal laceration during delivery, IIIc).

Again, documentation will be important, Witt says. The American Congress of Obstetricians and Gynecologists (ACOG) requested this change to improve data with regard to this type of laceration. Type 3a means that less than 50% of the External Anal Sphincter (EAS) is torn; type 3b indicates that more than 50% of the EAS is torn; and type 3c would mean that both the external and internal anal sphincter are torn.