Ob-Gyn Coding Alert

Shift your 641.1x codes to O44.1x codes in ICD-10.

When the placenta attaches itself to the uterine wall (close to or covering the cervix), the patient has placenta previa. The main symptom of placenta previa is sudden, painless vaginal bleeding.

Currently, you’ll report this condition with one of the following ICD-9-CM codes:

• 641.10, Hemorrhage from placenta previa unspecified as to episode of care
  
• 641.11, Hemorrhage from placenta previa with delivery
  
• 641.13, Hemorrhage from placenta previa antepartum
  

However, that changes after October 1, 2014. The ICD-10-CM codes you will report instead are:

• O44.10, Placenta previa with hemorrhage, unspecified trimester
  
• O44.11, Placenta previa with hemorrhage, first trimester
  
• O44.12, Placenta previa with hemorrhage, second trimester
  
• O44.13, Placenta previa with hemorrhage, third trimester
  

Difference: Your three ICD-9-CM options expand to four options in ICD-10-CM. No longer does your code selection depend on the patient delivering or having antepartum status. Instead, you should choose your ICD-10 code based on the trimester of the pregnancy at the time of the encounter.

Documentation: Specific terms you should look for include:

• Low implantation of placenta, NOS or with hemorrhage
  
• Marginal placenta previa, NOS or with hemorrhage
  
• Partial placenta previa, NOS or with hemorrhage
• Total placenta previa, NOS or with hemorrhage
  

Here is how you will find these codes in your Alphabetic Index:

Delivery (childbirth) (labor)

- cesarean (for)
- - placenta previa O44.1-
- complicated O75.9
- - by
- - - hemorrhage (uterine) O67.9
- - - - due to
- - - - - low-lying placenta O44.1-
- - - - - placenta previa O44.1-
- - - malposition, malpresentation
- - - - placenta (with hemorrhage) O44.1-
- - - placenta, placental
- - - - low (implantation) O44.1-
- - - - - without hemorrhage O44.0-
- - - - malposition O44.1-
- - - - previa (central) (lateral) (low) (marginal) (partial) (total) O44.1-
- - - - vicious insertion O44.1-
- complicated by (care of) (management affected by)
- - abnormal, abnormality
- - - position
- - - - placenta O44.1-
Hemorrhage, hemorrhagic (concealed) R58
- antepartum (with) O46.90
- - due to
- - - placenta previa O44.1-

Coder tips: You do have an unspecified option, but you should not use this code very often. Instead, look at your provider’s documentation to determine the patient’s trimester.

Underneath the O44.1 category (Placenta previa with hemorrhage), you have an Excludes1 note that forbids you from reporting any of these codes with labor and delivery complicated by hemorrhage from vasa previa (O69.4).