Ob-Gyn Coding Alert

You also have 3 obstetric guideline changes to adopt.

For obstetric patients, you have new fetal abnormality maternal care codes as well as some guideline tweaks to learn. Educating yourself about these changes sooner rather than later will prepare you and your claims for Oct. 1, 2022.

Adopt New Maternal Care for Fetal Abnormality Codes

The code category O35 for central nervous system (CNS) and chromosomal anomalies in the fetus have been greatly expanded to include more specific descriptions of maternal anomalies, says Melanie Witt, MA, RN, an ob-gyn coding expert based in Guadalupita, New Mexico.

These new codes will “enable better tracking, measurement, and ultimately improved treatment modalities for identified fetal anomalies,” according to the ICD-10 Committee Meeting Notes. The Notes go on to say: “The absence of antenatal ICD-10-CM codes to reflect many of the same diagnoses limits the ability to assess the quality of the antenatal diagnosis as well as the evaluation of the different treatment modalities proposed for some of these diagnoses.”

Remember, you should only report these conditions if they have been confirmed, advises the ICD-10 Committee in the Meeting Notes.

Heads up: “As a reminder, this code category requires a 7th character to indicate the fetus that is affected. A 7th character of ‘0’ would be mean a singleton pregnancy, ‘1-5’ means twin 1-5, and ‘9’ means a fetus from a multiple pregnancy greater than 5,” Witt says.

The new maternal care for central nervous system malformation in the fetus codes are:

• O35.00- (Maternal care for (suspected) central nervous system malformation or damage in fetus, unspecified)
• O35.01- (… agenesis of the corpus callosum)
• O35.02- (… anencephaly)
• O35.03- (… choroid plexus cysts)
• O35.04- (… encephalocele)
• O35.05- (… holoprosencephaly)
• O35.06- (… hydrocephaly)
• O35.07- (… microcephaly)
• O35.08- (… spina bifida)
• O35.09- (Maternal care for (suspected) other central nervous system malformation or damage in fetus)

Example: If your ob-gyn documents CNS damage in a singleton pregnancy, you must add the place keeper X. This would make this code O35.00X0.

The chromosomal abnormality in fetus new maternal care codes are:

• O35.10- (Maternal care for (suspected) chromosomal abnormality in fetus, unspecified)
• O35.11- (… Trisomy 13)
• O35.12- (… Trisomy 18)
• O35.13- (… Trisomy 21)
• O35.14- (… Turner Syndrome)
• O35.15- (… sex chromosome abnormality)
• O35.19- (… other chromosomal abnormality)

Example: If your ob-gyn suspects a chromosomal abnormality of Trisomy 21 in the second twin in a multiple-gestation pregnancy, you should report O35.13XX2.

The new maternal care for other fetal abnormality/damage codes are:

• O35.A- (Maternal care for other (suspected) fetal abnormality and damage, fetal facial anomalies)
• O35.B- (… fetal cardiac anomalies)
• O35.C- (… fetal pulmonary anomalies)
• O35.D- (… fetal gastrointestinal anomalies)
• O35.E- (… fetal genitourinary anomalies)
• O35.F- (… fetal musculoskeletal anomalies of trunk)
• O35.G- (… fetal upper extremities anomalies)
• O35.H- (… fetal lower extremities anomalies)

Example: To report an O35.A- code for a singleton pregnancy, you would report O35.AXX0.

Highlight These Obstetric Guideline Changes

ICD-10-CM added a bevy of new diagnosis codes, but it also shifted some guidelines as well. If you miss these tweaks, you could cause your claim to be denied.

First, you have a new section added, which is 15.a.7. This describes what “completed” weeks of gestation means. It states:

“7) Completed weeks of gestation. In ICD-10-CM, “completed” weeks of gestation refers to full weeks. For example, if the provider documents gestation at 39 weeks and 6 days, the code for 39 weeks of gestation should be assigned, as the patient has not yet reached 40 completed weeks.”

Second, under Section 15.i, you will find the following statement was added: