Ob-Gyn Coding Alert

AHA Coding Clinic clarifies why you shouldn't make this mistake.

If your ob-gyn sees a patient who requires induced labor, you might be tempted to report 644.21 (Early onset of delivery, delivered, with or without mention of antepartum condition). However, you should not report this code -- because the labor is induced and not premature.

Remember: "Premature labor" means that uterine contractions begin at weeks 20-36 of the patient's pregnancy. "Induced labor" means that labor is brought on by mechanical other extraneous means, usually by the intravenous infusion of oxytocin.

Example: Suppose a patient with twins (at 34 weeks) underwent a sonogram, and the ob-gyn diagnosed the first baby with oligohydramnios and the second baby with IUGR (intrauterine growth retardation). The ob-gyn admits the patient to labor and delivery, so that he can induce her labor. Due to IUGR, he uses Cervidil, and the patient gives birth to twins by normal spontaneous vaginal delivery. She experienced no complications. His discharge diagnosis was "preterm delivery." What should you report?

Not 644.21, says AHA Coding Clinic Q3 2011. The IUGR (656.51) and oligohydraminios, delivered (658.01), and twins delivered (651.01) plus V27.2. There is no code for an induced delivery.

ICD-10: When your diagnosis system changes in 2014, code 644.21 will become:

• O60.12X0 -- Preterm labor second trimester with preterm delivery second trimester, not applicable or unspecified
• O60.13X0 -- Preterm labor second trimester with preterm delivery third trimester, not applicable or unspecified
• O60.14X0 -- Preterm labor third trimester with preterm delivery third trimester, not applicable or unspecified

Code 656.51 will become:

• O36.5110 -- Maternal care for known or suspected placental insufficiency, first trimester, not applicable or unspecified
• O36.5120 -- Maternal care for known or suspected placental insufficiency, second trimester, not applicable or unspecified
• O36.5130 -- Maternal care for known or suspected placental insufficiency, third trimester, not applicable or unspecified
• O36.5910 -- Maternal care for other known or suspected poor fetal growth, first trimester, not applicable or unspecified
• O36.5920 -- Maternal care for other known or suspected poor fetal growth, second trimester, not applicable or unspecified
• O36.5930 -- Maternal care for other known or suspected poor fetal growth, third trimester, not applicable or unspecified

Code 658.01 will become:

• O41.01X0 -- Oligohydramnios, first trimester, not applicable or unspecified
• O41.02X0 -- Oligohydramnios, second trimester, not applicable or unspecified
• O41.03X0 -- Oligohydramnios, third trimester, not applicable or unspecified

Code 651.01 will become:

• O30.001 -- Twin pregnancy, unspecified number of placenta and unspecified number of amniotic sacs, first trimester
• O30.002 -- Twin pregnancy, unspecified number of placenta and unspecified number of amniotic sacs, second trimester
• O30.003 -- Twin pregnancy, unspecified number of placenta and unspecified number of amniotic sacs, third trimester

Code 651.01 will also have the following categories: O30.01-- and O30.02-- to O30.09--.