Ob-Gyn Coding Alert

Tip: Indicate the fetus with your seventh character.

Preterm labor is the presence of uterine contractions of sufficient frequency and intensity to effect progressive effacement and dilation of the cervix, prior to term gestation (between 20-37 weeks). Preterm labor precedes almost half of preterm births, and preterm birth is the leading cause of neonatal mortality in the United States.

ICD-9-CM Codes: Right now, you would report this condition with:

• 644.00, Threatened premature labor, unspecified as to episode of care or not applicable

• 644.03, Threatened premature labor, antepartum condition or complication

• 644.20, Early onset of delivery, unspecified as to episode of care or not applicable

• 644.21, Early onset of delivery, delivered, with or without mention of antepartum condition
  

ICD-10-CM Codes: However, when ICD-10 goes into effect, you should report this condition with the following codes:

O60.00, Preterm labor without delivery, unspecified trimester

O60.02, ... second trimester

O60.03, ... third trimester

O60.10--, Preterm labor with preterm delivery, unspecified trimester

O60.10X0, ... not applicable or unspecified

O60.10X1, ... fetus 1

O60.10X2, ... fetus 2

O60.10X3, ... fetus 3

O60.10X4, ... fetus 4

O60.10X5, ... fetus 5

O60.10X9, ... other fetus

O60.12--, Preterm labor second trimester with preterm delivery second trimester

O60.12X0, ... not applicable or unspecified

O60.12X1, ... fetus 1

O60.12X2, ... fetus 2

O60.12X3, ... fetus 3

O60.12X4, ... fetus 4

O60.12X5, ... fetus 5

O60.12X9, ... other fetus

O60.13--, Preterm labor second trimester with preterm delivery third trimester

O60.13X0, ... not applicable or unspecified

O60.13X1, ... fetus 1

O60.13X2, ... fetus 2

O60.13X3, ... fetus 3

O60.13X4, ... fetus 4

O60.13X5, ... fetus 5

O60.13X9, ... other fetus

O60.14--, Preterm labor third trimester with preterm delivery third trimester

O60.14X0, ... not applicable or unspecified

O60.14X1, ... fetus 1

O60.14X2, ... fetus 2

O60.14X3, ... fetus 3

O60.14X4, ... fetus 4

O60.14X5, ... fetus 5

O60.14X9, ... other fetus

O60.20--, Term delivery with preterm labor, unspecified trimester

O60.20X0, ... not applicable or unspecified

O60.20X1, ... fetus 1

O60.20X2, ... fetus 2

O60.20X3, ... fetus 3

O60.20X4, ... fetus 4

O60.20X5, ... fetus 5

O60.20X9, ... other fetus

O60.22--, Term delivery with preterm labor, second trimester

O60.22X0, ... not applicable or unspecified

O60.22X1, ... fetus 1

O60.22X2, ... fetus 2

O60.22X3, ... fetus 3

O60.22X4, ... fetus 4

O60.22X5, ... fetus 5

O60.22X9, ... other fetus

O60.23--, Term delivery with preterm labor, third trimester

O60.23X0, ... not applicable or unspecified

O60.23X1, ... fetus 1

O60.23X2, ... fetus 2

O60.23X3, ... fetus 3

O60.23X4, ... fetus 4

O60.23X5, ... fetus 5

O60.23X9, ... other fetus

ICD-10-CM Change: To correctly choose your preterm labor code, you need to know:

Did the patient deliver? If not, look at O60.0-.

If the patient has preterm labor and delivers prematurely, you need to know what trimester the preterm labor occurs in and what trimester she delivers in. 

If the patient has a term delivery with preterm labor, you need to know what trimester the preterm labor began. Remember, a term delivery, by definition, is greater than 37 weeks 0 days, and so this delivery would always be the third trimester. However, when did the preterm labor start? This would be where you get the third trimester, second trimester, or not specified.

Finally, you must know which fetus this affects to assign your seventh digit. 

Documentation: For preterm labor with delivery NOS, report O60.10X-. Remember to assign a 7th digit of ‘0’ for a singleton pregnancy, but a ‘1-9’ if this is a multiple gestation.  Note that an ‘X’ is also required as a place holder since the base code is only 5 characters.

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

Delivery (childbirth) (labor)

- preterm (see also Pregnancy, complicated by, preterm labor) O60.10

Pregnancy (childbirth) (labor) (puerperium) —see also Delivery and Puerperal

Note: the tabular must be reviewed for assignment of the final character for trimester, the tabular must be reviewed for assignment of the correct extension for multiple gestations for all chapter 15 codes

- complicated by (care of) (management affected by)

- - preterm delivery O60.10

- - preterm labor

- - - with delivery O60.10

- - - - preterm O60.10

- - - - term O60.20

- - - without delivery O60.00

- - - - second trimester O60.02

- - - - third trimester O60.03

- - - second trimester

- - - - with preterm delivery

- - - - - second trimester O60.12

- - - - - third trimester O60.13

- - - - with term delivery O60.22

- - - - without delivery O60.02

- - - third trimester

- - - - with term delivery O60.23

- - - - with third trimester preterm delivery O60.14

- - - - without delivery O60.03

Premature —see also condition

- delivery (see also Pregnancy, complicated by, preterm labor) O60.10

Preterm

- delivery (see also Pregnancy, complicated by, preterm labor) O60.10

Coder Tips: Under preterm labor (O60), you should notice the following notes:

Includes: onset (spontaneous) of labor before 37 weeks of gestation

Excludes1: false labor (O47.0-) and threatened labor NOS (O47.0-)