NTSV: Accurate Coding for Improved Quality Measures Program II: OB Diagnostic Coding Module 2: What is an Obstetrical Complication Grant Acknowledgement
Funding for this training series was made possible by a sub- award from the American College of Obstetricians and Gynecologists under Grant #UC4MC28042 from the Health Resources and Services Administration. The views expressed in the written materials and by speakers and moderators do not necessarily reflect the official policies of the Department of Health and Human Services nor does mention of trade names, commercial practices, or organizations imply endorsement by the U.S. Government. Resource Acknowledgement
Information presented in this module is directly resourced from the 2020 ICD-10-CM/PCS Official Guidelines for Coding and Reporting found on the Centers for Disease Control and Prevention website and the ICD-10-CM and ICD-10-PCS Coding Handbook With Answers published by the American Hospital Association. Our Faculty
Carole Liebner, RHIT, CDIP, CCS AHIMA APPROVED ICD-10-CM/PCS TRAINER AHIMA APPROVED REVENUE CYCLE TRAINER Director, Education & Program Development
Amber Owens, RHIA, CICA, CCS Director of Health Information Services Program II: Module 2 Topics
Explain obstetrical complications. Review abnormalities of labor. Understand malpresentations. Discuss pre-eclampsia and eclampsia. And a little assessment at the end to test your knowledge. Obstetrical Complication
An obstetrical complication is defined as “any condition or conditions that affect the management of the pregnancy or are exacerbated by the pregnancy.”
Conditions are considered to be complications of pregnancy unless the physician states that they are not.
Categories O60-O77 describe complications of labor and delivery.
Never assigned with code O80, Encounter for full-term uncomplicated delivery. Abnormalities of Labor Stages of Labor
First stage starts with recurring, strong contractions until the cervix is fully dilated.
Second stage is from full dilation to delivery of the baby.
Third stage is from delivery to expulsion of the placenta. Preterm Labor
Preterm labor is classified to category O60:
Onset of labor before 37 completed weeks of gestation. Preterm labor without delivery by trimester. Preterm labor with preterm delivery.
Preterm labor with preterm delivery
Second trimester with delivery second trimester
Second trimester with delivery third trimester
Third trimester with delivery third trimester Term delivery with preterm labor. Failed Induction of Labor
Failed induction of labor is classified to category O61.
Medical Instrumental Other Unspecified Abnormalities of Forces of Labor
Abnormalities of forces of labor is classified to category O62. Fourth characters specify: primary inadequate contractions secondary uterine inertia other uterine inertia precipitate labor hypertonic, incoordinate, and prolonged uterine contractions other abnormalities of labor and unspecified abnormalities of labor Prolonged Labor
Prolonged labor is classified to category O63:
Fourth character specifies the stages: prolonged first stage (O63.0) prolonged second stage (O63.1) delayed delivery of second twin, triplet, etc. (O63.2) unspecified (O63.9) Obstructed Labor
Obstructed labor occurs when the passage of the fetus through the pelvis is obstructed due to disproportion between the fetus’ head and the mother’s pelvis.
Can be caused by malpresentation, malposition, and/or fetal abnormalities. Malpresentations Malpresentation
Compound Presentation: This occurs when two different parts of the baby are set to exit the birth canal at the same time.
Shoulder Presentation: This happens when the shoulders are presented first, with the head tucked inside. Flexion Attitude
Flexion attitude refers to the position of the baby’s head. For a normal presentation, the head should be tucked down, into the chest. The two malpresentation for this factor are:
Face Presentation: The baby is looking up, set to emerge face first.
Brow Presentation: The baby’s head is in between the normal presentation and the face presentation. The forehead emerges first. Frank Breech
In a frank breech, the baby's buttocks lead the way into the birth canal.
The hips are flexed, the knees extended. This increases the chance of forming an umbilical cord loop that could precede the head through the cervix and cause injury to the baby if it is delivered vaginally. Transverse Lie
The baby lies crosswise in the uterus, making it likely that the shoulder will enter the pelvis first.
Most transverse lie babies are delivered by C- section. Occiput or Cephalic Posterior
Sometimes the baby is presenting head down as it should be, but it is facing the mother's abdomen.
This increases the chance of painful "back labor" and prolonged delivery. Complete Breech
This baby presents with the buttocks first; both the hips and the knees are flexed.
Like other breech presentations, this increases the risk of forming an umbilical cord loop that could precede the head through the cervix and cause injury to the baby if it is delivered vaginally. Footling Breech
Sometimes, one or both of the baby's feet are pointed down toward the birth canal.
This increases the chances of the umbilical cord slithering down into the mouth of the womb, cutting off blood supply to the baby. Other Indications for C-Section Delivery Multiples
Tw i n s Triplets Quadruplets Other 7th Character extension
Seventh characters 1–9 are for cases of multiple gestations to identify the fetus for which the code applies.
The seventh character 0, not applicable or unspecified, is used for the following situations:
Single gestations.
When the documentation in the record is insufficient to determine the fetus affected and it is not possible to obtain clarification.
When it is not possible to clinically determine which fetus is affected. Character for Fetus Involved
The fetus is assigned a character (number) (0-9) that indicates which fetus, usually in a multiple gestation, is associated with a problem such as malpresentation. 7th Character for Fetus
7th character 0 is for single gestations and multiple gestations where the fetus is unspecified. 7th characters 1 through 9 are for cases of multiple gestations to identify the fetus for which the code applies.
0 not applicable or unspecified 1 fetus 1 2 fetus 2 3 fetus 3 4 fetus 4 5 fetus 5 9 other fetus Fetal Distress
Category O68: Labor and delivery complicated by abnormality of fetal acid-base balance, describes fetal acidemia, fetal acidosis, fetal alkalosis, or fetal metabolic acidemia.
Category O76: Abnormality in fetal heart rate and rhythm complicating labor and delivery, includes fetal problems such as bradycardia, heart rate decelerations, heart rate irregularity, tachycardia, and non-reassuring fetal heart rate or rhythm.
Category O77: Other fetal stress complicating labor and delivery, includes codes for meconium in amniotic fluid (O77.0), fetal stress due to drug administration (O77.1), and other evidence of fetal stress (O77.8). Pre-eclampsia & Eclampsia
Pre-eclampsia, sometimes called toxemia of pregnancy, is high blood pressure accompanied by proteinuria or edema.
In pre-eclampsia, blood pressure is higher than 140/90 mm Hg, the face or hands of the woman swell, and abnormally high levels of protein are detected in the urine.
Pre-eclampsia is characterized by elevated blood pressure, proteinuria, and edema.
Eclampsia describes one or more convulsions, or seizures, occurring during or immediately after pregnancy as a complication of pre-eclampsia. HELLP Syndrome
HELLP is the medical term for one of the most serious complications of pre-eclampsia, in which there is a combined liver and blood clotting disorder.
HELLP Syndrome is a group of symptoms that occur in pregnant women who have: (H) hemolytic anemia (EL) elevated liver enzymes, and (LP) low platelet count Placenta Previa
Placenta Previa is the implantation of the placenta in the lower part of the uterus near or over the cervical opening. The severity of the condition depends on how much of the placenta is situated close to the cervix.
Mild placenta Previa may be discovered by ultrasound, but has no adverse effect on the pregnancy.
A more serious placenta Previa results in vaginal bleeding late in a pregnancy, which places the mother and baby at higher risk. If the bleeding is heavy and the patient is near term, an immediate delivery, usually by C-section, is carried out. Abruptio Placentae
Abruptio Placentae is a condition characterized by a premature detachment of the placenta, often putting the patient into shock and producing oliguria and decreased fibrinogen, causing a high mortality risk. Assessment Question 1
True/False:
Obstructed labor is when the passage of the fetus through the pelvis is mechanically obstructed. Question 1 - True
Obstructed labor occurs when the passage of the fetus through the pelvis is obstructed due to disproportion between the fetus’ head and the mother’s pelvis. Question 2
True/False:
Most transverse lie babies are born via C-section. Question 2 - True
The baby lies crosswise in the uterus, making it likely that the shoulder will enter the pelvis first.
Most transverse lie babies are delivered by C-section. Question 3
Name 3 types of breech malpresentation:
a. Complete, Incomplete, Vertex b. Footling, Frank, Transverse c. Vertex, Occiput, Face/Brow d. Vaginal, C-section, Vacuum Question 3 - Answer
Name 3 types of breech malpresentation:
a. Complete, Incomplete, Vertex b. Footling, Frank, Transverse c. Vertex, Occiput, Face/Brow d. Vaginal, C-section, Vacuum Question 4
What is an appropriate indication for C-section?
a. Scheduling b. Tired of being pregnant c. Multiple gestation d. Rupture of membranes Question 4 - Answer
What is an appropriate indication for C-section?
a. Scheduling b. Tired of being pregnant c. Multiple Gestation d. Rupture of Membranes Question 5
True/False:
C-sections should be done when the woman’s obstetrician is going on vacation. Question 5 - False
A C-section should not be scheduled for convenience of either the mom or the obstetrician. References
ICD-10-CM Official Guidelines for Coding and Reporting FY 2020. (2020). Centers for Disease Control and Prevention. Retrieved from https://www.cdc.gov/nchs/data/icd/10cmguidelines-FY2020_final.pdf Leon-Chisen, N. (2020). ICD-10-CM and ICD-10-PCS Coding Handbook With Answers. American Hospital Association. Chicago, IL. AHA Press. Thank You!
Carole Liebner, RHIT, CDIP, CCS [email protected] Amber Owens, RHIA, CICA, CCS [email protected] Disclaimer
The codes and other information presented here are for educational purposes only, and should not be depended upon or utilized by any person for any other purpose, including coding or billing. Always consult official sources, such as Coding Clinic, the Official Guidelines, and other credible sources for confirmation and additional information. Official sources are available from the Cooperating Parties, which include the American Health Information Management Association (AHIMA), the Centers for Medicare and Medicaid Services (CMS), the National Center for Health Statistics (NCHS), and the American Hospital Association (AHA). HRET and its instructors explicitly deny any liability for any dependence upon the codes and other information presented in this material for any unauthorized purpose or for any other misapplication of the same.
Source: HEALTH RESEARCH & EDUCATION TRUST OF NJ Copyright: 2020 Health Research & Education Trust of NJ