Ob-Gyn Coding Alert

Question:  We are working on our crosswalk. A scenario that has us stumped:  Patient admitted with mild pre-eclampsia in the 2nd trimester, stays until delivery in the 3rd trimester with moderate/mild pre-eclampsia. What would be the delivery codes? There is not an “in childbirth” code for pre-eclampsia. Vaginal or C/S. How would this be coded?

California Subscriber

Answer: Mild to moderate pre-eclampsia (without pre-existing hypertension) is coded by trimester only. You won’t find any “in childbirth” codes for this diagnosis and no combination codes that indicate one condition is one trimester with another condition in a different trimester (like pre-term labor with term delivery).

The ICD-10 guidelines that apply to your scenario would be: In instances when a patient is admitted to a hospital for complications of pregnancy during one trimester and remains in the hospital into a subsequent trimester, the trimester character for the antepartum complication code should be assigned on the basis of the trimester when the complication developed, not the trimester of the discharge. If the condition developed prior to the current admission/encounter or represents a pre-existing condition, the trimester character for the trimester at the time of the admission/encounter should be assigned.

So in this case, as you will have no “in childbirth” code, you should assign the trimester when she was admitted. If the reason for admission is the reason that supports the cesarean or vaginal birth, you should list that diagnosis first. If the reason for admission is not related to the reason for the birth, you should list the admitting diagnosis first.