Obstetrical and Newborn Coding
Tips for ICD-10-CM and PCS
With the implementation of ICD-10-CM and ICD-10-PCS, some areas of obstetrical and newborn coding have become a little more complicated than we were previously used to. There were a lot of changes to the diagnosis codes, and new root operations to consider when coding procedures, which continues to cause confusion with coders.
Probably the biggest challenge is appropriately assigning the trimester qualifier versus the in-childbirth qualifier when assigning obstetrical diagnosis codes. Not all codes have the “in childbirth” qualifier, so it is important for the coder to carefully examine all of the options for the particular diagnosis. The code for anemia O99.0xx) is a good example of a diagnosis that has multiple qualifiers – first trimester, second trimester, third trimester, in childbirth, and during the puerperium. If the patient presents for delivery and the physician documents she has anemia, then it is appropriate to use the “in childbirth” qualifier.
Fetal monitoring is performed on many women during the course of labor. The typical type of monitoring used is external fetal monitoring, where a transducer is worn like a belt. Most facilities do not require the coder to assign a code for the external fetal monitor.
Induction of labor has been used more and more frequently since the mid-1990’s. Over the years, more and more types of induction have been used, but the most commonly used procedures are artificial rupture of membranes (AROM), IV medication (typically Pitocin); cervical gel insertion (prostaglandin), and foley bulb insertion. In order to code this procedure correctly, first the coder has to understand the difference between labor induction and labor augmentation.
Induction of labor occurs when there is no definitive labor pattern established at the time the medication is given. Augmentation of labor infers that there is an established labor pattern, but labor may not be progressing well (ineffective contractions). Sometimes an established labor pattern is given a “boost” by either rupturing the membranes or administering some Pitocin, and should not be assigned an induction code. Cervical gel insertion requires the placement of a gel-filled capsule containing prostaglandin against the cervix to soften the cervix (often referred to as ripening), thus allowing for dilation. The last mode of induction is classified in ICD-10-CM as a surgical induction, and consists of a foley catheter bulb being threaded into the cervix. The saline bulb in the catheter is filled with saline, thus expanding the cervix.
The last area to be discussed are codes from the newborn section, specifically P03.X. These codes are only to be coded on the newborn chart, not on the mom’s chart. The P03 section are used to reflect a newborn affected by other complications of labor and delivery. Basically this means that these codes can only be assigned fi the physician specifically states a complication of the labor and/or delivery directly affected the well being of the baby. A good example of this is when the baby is delivered with a nuchal cord around it’s neck; unless the physician documents an adverse outcome of the nuchal cord (respiratory distress, aspiration, etc), a code from the P03 section should not be assigned. Many times the presence of a nuchal cord is documented, but there are no untoward event associated with it.
Obstetrical and newborn coding has always been somewhat challenging but has become even more so in ICD-10-CM and ICD-10-PCS. Coders must be aware of the documentation requirements, indexing, and knowledge of the procedures being performed in order to apply the correct diagnosis and procedure codes.
Director of Client Services at Excite Health Partners