Download for ICD-10

Anatomy and
Pathophysiology
for
ICD-10
2014
Module 13
Disclaimer
This course was current at the time it was published. This course was prepared as a tool to assist the participant in
understanding how to prepare for ICD-10-CM. Although every reasonable effort has been made to assure the accuracy of the information within these pages, the ultimate responsibility of the use of this information lies with the
student. AAPC does not accept responsibility or liability with regard to errors, omissions, misuse, and misinterpretation. AAPC employees, agents, and staff make no representation, warranty, or guarantee that this compilation of
information is error-free and will bear no responsibility, or liability for the results or consequences of the use of this
course.
AAPC does not accept responsibility or liability for any adverse outcome from using this study program for any
reason including undetected inaccuracy, opinion, and analysis that might prove erroneous or amended, or the coder’s
misunderstanding or misapplication of topics. Application of the information in this text does not imply or guarantee
claims payment. Inquiries of your local carrier(s)’ bulletins, policy announcements, etc., should be made to resolve
local billing requirements. Payers’ interpretations may vary from those in this program. Finally, the law, applicable
regulations, payers’ instructions, interpretations, enforcement, etc., may change at any time in any particular area.
This manual may not be copied, reproduced, dismantled, quoted, or presented without the expressed written approval
of the AAPC and the sources contained within. No part of this publication covered by the copyright herein may be
reproduced, stored in a retrieval system or transmitted in any form or by any means (graphically, electronically, or
mechanically, including photocopying, recording, or taping) without the expressed written permission from AAPC
and the sources contained within.
ICD-10 Experts
Rhonda Buckholtz, CPC, CPMA, CPC-I, CGSC, CPEDC, CENTC, COBGC
VP, ICD-10 Training and Education
Shelly Cronin, CPC, CPMA, CPC-I, CANPC, CGSC, CGIC, CPPM
Director, ICD-10 Training
Betty Hovey, CPC, CPMA, CPC-I, CPC-H, CPB, CPCD
Director, ICD-10 Development and Training
Jackie Stack, CPC, CPB, CPC-I, CEMC, CFPC, CIMC, CPEDC
Director, ICD-10 Development and Training
Peggy Stilley, CPC, CPB, CPMA, CPC-I, COBGC
Director, ICD-10 Development and Training
Illustration copyright © OptumInsight. All rights reserved.
©2013 AAPC
2480 South 3850 West, Suite B, Salt Lake City, Utah 84120
800-626-CODE (2633), Fax 801-236-2258, www.aapc.com
Revised 111213. All rights reserved.
CPC®, CPC-H®, CPC-P®, CPMA®, CPCO™, and CPPM® are trademarks of AAPC.
ii
Anatomy and Pathophysiology for ICD-10
UnitedHealthcare
© 2013 AAPC. All rights reserved.
111213
Contents
Module 13
Pregnancy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
Terminology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
Diseases and Disorders in Pregnancy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7
© 2013 AAPC. All rights reserved. 111213
UnitedHealthcare
www.aapc.com
iii
Module
Pregnancy
13
Terminology
Amenorrhea—Absence of menses.
Amniotoic fluid—Liquid produced by (and contained
within) the fetal membranes during pregnancy.
Cesarean section—Surgical procedure where the baby
is delivered transabdominally.
Eclampsia—Most severe form of hypertension during
pregnancy.
EDD—Expected date of delivery.
Embryo—Name given to product of conception from
the second through eighth week of pregnancy.
Endometrium—Inner lining of the uterus.
Amniotic
space
LMP—Last menstrual period.
Ovum—Female sex cell.
Umbilical cord—Serves as a lifeline to the fetus.
Zygote—Fertilized ovum.
Introduction
Pregnancy starts with fertilization and ends with childbirth in an average span of 38 weeks. During the gestational period the zygote divides as it passes through
the fallopian tube and attaches to the uterine lining via
implantation. Through complex sequences of development the zygote is transformed into a full-term fetus.
Copyright OptumInsight. All rights reserved
Course of Pregnancy
A scientific term for pregnancy is gravid, thus referring
to a pregnant female as gravida. The term parity (used
as para) is used for the number of previous successful
live births. So, a woman currently pregnant with her
third baby with two live births previously is considered
Gravida 3 Para 2. Other pregnancy terms:
• Nulligravida—A woman who has never been
pregnant (also called nulliparous)
• Primigravida—A woman pregnant for the first time
• Multigravida—A woman in a subsequent pregnancy
(also called multiparous)
• Abortion—Death of embryo or fetus whether
spontaneous or induced
© 2013 AAPC. All rights reserved. 111213
UnitedHealthcare
www.aapc.com
1
Pregnancy
Module 13
The course of pregnancy is usually broken down into
trimesters. According to ICD-10-CM the break down for
the trimesters are:
• 1st trimester—less than 14 weeks 0 days
• 2nd trimester—14 weeks 0 days to less than 28
weeks 0 days
• 3rd trimester—28 weeks 0 days until delivery
First Trimester
Traditionally, doctors have measured pregnancy from
a number of convenient points, including the day of
last menstruation, ovulation, fertilization, implantation, and chemical detection. In medicine, pregnancy is
often defined as beginning when the developing embryo
becomes implanted into the endometrial lining of a
woman’s uterus. Most pregnant women do not have any
specific signs or symptoms of implantation, although
it is not uncommon to experience minimal bleeding
at implantation. Some women will also experience
cramping during their first trimester. This is usually
of no concern unless there is spotting or bleeding as
well. After implantation the uterine endometrium is
called the decidua. The placenta, which is formed partly
from the decidua and partly from outer layers of the
embryo, connects the developing fetus to the uterine
wall to allow nutrient uptake, waste elimination, and gas
exchange via the mother’s blood supply. The umbilical
cord is the connecting cord from the embryo or fetus to
the placenta. The developing embryo undergoes tremendous growth and changes during the process of fetal
development.
In some cases a complication may occur where the fertilized egg might implant itself in the fallopian tubes, the
cervix, and the ovary—or in the abdomen, causing an
ectopic pregnancy. In the case of an ectopic pregnancy
there is no way for the pregnancy to progress normally.
If left untreated, it can cause harm and possibly death
for the mother when a rupture occurs. It may go away on
its own, or it may need surgical removal or medicine to
remove the tubal pregnancy since there is no way of the
pregnancy being able to continue safely.
A common occurrence in pregnancy is morning sickness. About 70 percent of all pregnant women will
encounter this condition and it typically improves after
the first trimester. Although described as “morning
2
Anatomy and Pathophysiology for ICD-10
sickness,” women can experience this nausea during
afternoon, evening, and throughout the entire day.
In the first 12 weeks of pregnancy, the nipples and
areolas darken due to a temporary increase in hormones.
The first two weeks from the first trimester are calculated as the first two weeks of pregnancy even though
the pregnancy does not actually exist. These two weeks
are the two weeks before conception and include the
woman’s last period.
The third week is the week in which fertilization occurs
and the fourth week is the period when implantation
takes place. In the fourth week, the fecundated egg
reaches the uterus and burrows into its wall which
provides it with the nutrients it needs. At this point, the
zygote becomes a blastocyst and the placenta starts to
form. Moreover, most of the pregnancy tests may detect
a pregnancy beginning with this week.
The fifth week marks the start of the embryonic period.
This is when the baby’s brain, spinal cord, heart and
other organs begin to form. At this point the embryo is
made up of three layers, of which the top one (called the
ectoderm) will give rise to the baby’s outermost layer of
skin, central and peripheral nervous systems, eyes, inner
ear, and many connective tissues. The heart and the
beginning of the circulatory system as well as the bones,
muscles and kidneys are made up from the mesoderm
(the middle layer). The inner layer of the embryo will
serve as the starting point for the development of the
baby’s lungs, intestine and bladder. This layer is referred
to as the endoderm. A baby at five weeks is normally
between 1⁄16 and 1⁄8 inch (1.6 and 3.2 mm) in length.
In the 6th week, the baby will be developing basic facial
features and its arms and legs start to grow. At this point,
the embryo is usually no longer than 1⁄6 to 1⁄4 inch (4.2
to 6.3 mm). In the following week, the brain, face, arms,
and legs quickly develop. In the 8th week, the baby starts
moving and in the next three weeks, the baby’s toes,
neck, and genitals develop as well. By the end of the first
trimester, the fetus will be about 3 inches (76 mm) long
and will weigh approximately 1 ounce (28 g).
Second Trimester
Most women feel more energized in the second trimester
and begin to put on weight as the symptoms of morning
sickness subside and eventually fade away. In the 20th
UnitedHealthcare
© 2013 AAPC. All rights reserved.
111213
Module 13
Pregnancy
week the uterus can expand up to 20 times its normal
size during pregnancy. In the second trimester quickening occurs, when movement of the fetus is finally
felt. This typically happens in the fourth month, more
specifically in the 20th to 21st week, or by the 19th week
if the woman has been pregnant before. However, it is not
uncommon for some women not to feel the fetus move
until much later. The placenta fully functions at this time
and the fetus makes insulin and urinates. The reproductive organs distinguish the fetus as male or female.
Third Trimester
Final weight gain takes place, which is the most weight
gain throughout the pregnancy. The fetus will be growing
the most rapidly during this stage, gaining up to 28 g per
day. The woman’s belly will transform in shape and her
belly will drop because the fetus is turning in a downward position to get ready for birth. The fetus begins
to move regularly, and can be felt often by the woman.
Fetal movement can become quite strong at this point.
Sometimes the woman’s navel will pop out and become
convex. This period of her pregnancy can be uncomfortable due to: symptoms such as weak bladder control and
backache, feeling the fetus “rolling” causing pain and
discomfort if the is near the woman’s ribs or spine.
The fetus’ movement becomes stronger and more
frequent due to improved eye, brain, and muscle
function. Head engagement occurs when the fetal head
descends into the pelvic cavity. This is termed as the baby
dropping or the lightening. However, it severely reduces
bladder capacity and increases pressure on the pelvic
floor and the rectum. This sometimes causes the mother
to experience the perpetual sensation that the fetus will
“fall out” at any moment. The perineum and cervix are
further flattened and the head may be felt vaginally.
Complications of Pregnancy
Pregnancy poses varying levels of health risks for women,
depending on their medical profile before pregnancy.
The following are some of the complaints that may occur
during and/or after pregnancy due to the many changes
which pregnancy causes in a woman’s body:
• Anemia
• Back pain. A common complaint in the third trimester when the patient’s center of gravity has shifted.
© 2013 AAPC. All rights reserved. 111213
• Constipation. A complaint that is caused by decreased
bowel mobility secondary to elevated progesterone
which can lead to greater absorption of water.
• Braxton Hicks contractions. Occasional, irregular,
and often painless contractions that occur several
times per day.
• Edema. Common complaint in advancing
pregnancy. Caused by compression of the inferior
vena cava (IVC) and pelvic veins by the uterus
leads to increased hydrostatic pressure in lower
extremities.
• Regurgitation, heartburn, and nausea. May be
caused by Gastroesophageal Reflux Disease (GERD).
• Hemorrhoids. Complaint that is often noted in
advancing pregnancy. Caused by increased venous
stasis and IVC compression leading to congestion
in venous system, along with increased abdominal
pressure secondary to the pregnant space-occupying
uterus and constipation.
• Pelvic girdle pain (PGP). This disorder is complex
and multi-factorial and likely to be represented by
a series of sub-groups with different underlying
pain drivers. Musculo-Skeletal Mechanics
involved in gait and weight-bearing activities
can be mild to grossly impaired. PGP can begin
peri or postpartum. There is pain, instability,
or dysfunction in the symphysis pubis and/or
sacroiliac joints.
• Round Ligament Pain. Pain experienced when the
ligaments positioned under the uterus stretch and
expand to support the woman’s growing uterus.
• Thromboembolic disorders. A leading cause of
death in pregnant women.
• Increased urinary frequency. Caused by increased
intravascular volume, elevated GFR (glomerular
filtration rate), and compression of the bladder by
the expanding uterus.
• Urinary tract infection
• Varicose veins. Caused by relaxation of the venous
smooth muscle and increased intravascular pressure.
• Pruritic Urticarial Papules and Plaques of Pregnancy
(PUPPP). This is a skin disease that develops around
the 32nd week with itchiness around the belly button
and red plaques and papules that spread all over the
body except for the inside of the hands and face.
UnitedHealthcare
www.aapc.com
3
Pregnancy
Module 13
First Stage: Dilation
• Postpartum depression
• Postpartum psychosis
Childbirth
Childbirth, or labor, birth, partus, parturition. This is
the end of the pregnancy with the birth of one or more
newborn infants. A woman is considered to be in labor
when she begins experiencing regular uterine contractions, accompanied by changes of her cervix—primarily
effacement and dilation. All changes in the soft tissues of
the cervix and the birth canal depend on the successful
completion of these six phases:
1. Engagement of the fetal head in the transverse
position. The baby’s head is facing across the pelvis
at one or other of the mother’s hips.
2. Descent and flexion of the fetal head.
3. Internal rotation. The fetal head rotates 90 degrees
to the occipito-anterior position so that the baby’s
face is towards the mother’s rectum.
4. Delivery by extension. The fetal head passes out of
the birth canal. Its head is tilted backwards so that
its forehead leads the way through the vagina.
5. Restitution. The fetal head turns through 45
degrees to restore its normal relationship with the
shoulders, which are still at an angle.
6. External rotation. The shoulders repeat the corkscrew movements of the head, which can be seen in
the final movements of the fetal head.
Latent Phase
The latent phase of labor (prodromal labor) may last
many days and the contractions are an intensification of
the Braxton-Hicks contractions that may start around
26 weeks gestation. Cervical effacement occurs during
the closing weeks of pregnancy and is usually complete
or near complete, by the end of the latent phase. The
degree of cervical effacement may be felt during a
vaginal examination. A ‘long’ cervix implies that not
much has changed in the lower segment, and vice versa
for a ‘short’ cervix. Latent phase ends with the onset of
active first stage; when the cervix is about 3 cm dilated.
4
Anatomy and Pathophysiology for ICD-10
There are several factors that midwives and clinicians
use to assess the laboring mother’s progress, and these
are defined by the Bishop Score. The total score is
achieved by assessing the following five components on
vaginal examination:
•
•
•
•
•
Cervical dilation
Cervical effacement
Cervical consistency
Cervical position
Fetal station
The Bishop score grades patients who would be most
likely to achieve a successful induction. Each component is given a score of 0-2 or 0-3. The highest possible
score is 13. The duration of labor is inversely correlated
with the Bishop score; a score that exceeds 8 describes
the patient most likely to achieve a successful vaginal
birth. Bishop scores of less than 6 usually require that a
cervical ripening method be used before other methods.
The first stage of labor starts classically when the effaced
cervix is 3 cm dilated. There is a variation in this point
as some women may or may not have active contractions
prior to this. The onset of actual labor is defined when
the cervix begins to progressively dilate, with or without
rupture of the membranes or a blood stained ‘show’.
Uterine muscles form opposing spirals from the top of
the upper segment of the uterus to its junction with the
lower segment. During effacement, the cervix becomes
incorporated into the lower segment of the uterus.
During a contraction, these muscles contract causing
shortening of the upper segment and drawing upwards
of the lower segment, in a gradual expulsive motion.
This draws the cervix up over the baby’s head. Full dilation is reached when the cervix has widened enough to
allow passage of the baby’s head, around 10 cm dilation
for a term baby.
The duration of labor varies widely. Active phase arrest
is defined in a primigravida woman as the failure of the
cervix to dilate at a rate of 1.2 cm/hr over a period of at
least two hours. This definition is based on Friedman’s
Curve, which plots an ideal rate of cervical dilation and
fetal descent during active labor.
UnitedHealthcare
© 2013 AAPC. All rights reserved.
111213
Module 13
Pregnancy
Breech
clamped. Placental expulsion begins as a physiological
separation from the wall of the uterus. The placenta is
usually expelled within 15–30 minutes of the baby being
born. Placental expulsion can be managed actively, for
example by giving oxytocin via intramuscular injection followed by cord traction to assist in delivering the
placenta. Alternatively, it can be managed expectantly,
allowing the placenta to be expelled without medical
assistance.
Shoulder
(arm
prolapse)
Mother's
pelvis
Face
(mentum)
Compound
(extremity
together
with head)
The ICD-10-CM codes for pregnancy can be found in
chapter 15, Pregnancy, Childbirth and the Puerperium,
O00–O9a. To code this in ICD-10-CM the following is
necessary:
Oblique
• Trimester
• Gestational condition or pre-existing
• Type of complication
Copyright OptumInsight. All rights reserved
Second Stage: Fetal Expulsion
Following are examples of ICD-10-CM pregnancy codes:
This stage begins when the cervix is fully dilated, and
ends when the baby is finally born. As pressure on the
cervix increases, the Ferguson reflex increases uterine
contractions so that the second stage can go ahead. At
the beginning of the normal second stage, the head is
fully engaged in the pelvis; the widest diameter of the
head has successfully passed through the pelvic brim.
Ideally it has successfully also passed below the interspinous diameter which is the narrowest part of the
pelvis. If these have been accomplished, what remains is
for the fetal head to pass below the pubic arch and out
through the introitus. This is when the mother assists
by “bearing down” or pushing. The fetal head is seen to
‘crown’ as the labia part. At this point, the woman may
feel a burning or stinging sensation.
Birth of the fetal head signals the successful completion
of the fourth mechanism of labor (delivery by extension),
and is followed by the fifth and sixth mechanisms (restitution and external rotation). The second stage of labor
will vary to some extent, depending on how successfully
the preceding tasks have been accomplished.
Third Stage: Umbilical Cord
Closure and Placental Expulsion
The third stage of labor is the period from just after the
fetus is expelled until just after the placenta is expelled.
The umbilical cord is routinely clamped and cut in this
stage, but it would normally close naturally even if not
© 2013 AAPC. All rights reserved. 111213
Supervision of pregnancy with history of
ectopic or molar pregnancy, unspecified
trimester
O09.10
Supervision of pregnancy with history of
ectopic or molar pregnancy, first trimester
O09.11
Supervision of pregnancy with history
of ectopic or molar pregnancy, second
trimester
O09.12
Supervision of pregnancy with history of
ectopic or molar pregnancy, third trimester
O09.13
As demonstrated in the codes above, sometimes the
trimester is built into the code. According to the guidelines, assignment of final character for trimester should
be based on the trimester for the current admission/
encounter. This applies to the assignment of trimester
for pre-existing conditions as well as those that develop
during or are due to the pregnancy. Whenever delivery
occurs during the current admission, and there is an “in
childbirth” option for the obstetric complication being
coded, the “in childbirth” code should be assigned.
UnitedHealthcare
www.aapc.com
5
Pregnancy
Module 13
Maternal care for (suspected) central nervous
O35.0
system malformation in fetus
Maternal care for (suspected) chromosomal
abnormality in fetus
O35.1
Maternal care for (suspected) hereditary
disease in fetus
O35.2
Maternal care for (suspected) damage to fetus
O35.3
from viral disease in mother
Maternal care for (suspected) damage to fetus
O35.4
from alcohol
In the codes above, the 7th character extender is
necessary. It is shown in the next table.
One of the following 7th characters is to be assigned to
each code under category O35. 7th character 0 is used
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. The appropriate code
from category O30, Multiple gestations, must also be
assigned when assigning a code from category O35
that has a 7th character of 1 through 9.
0
not applicable or unspecified
1
fetus 1
2
fetus 2
3
fetus 3
4
fetus 4
5
fetus 5
9
other fetus
Anatomy and Pathophysiology for ICD-10
Single live birth
Z37.0
Single stillbirth
Z37.1
Twins, both liveborn
Z37.2
Twins, one liveborn and one stillborn
Z37.3
Twins, both stillborn
Z37.4
According to the guidelines, a code from category
Z37, Outcome of delivery, should be included on every
maternal record when a delivery has occurred. These
codes are not to be used on subsequent records or on the
newborn record.
Where applicable, a 7th character is to be assigned for
certain categories to identify the fetus for which the
complication code applies.
Assign 7th character “0”:
• For 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
Other important guidelines for chapter 15 state that
codes from this chapter have sequencing priority over
codes from other chapters. Additional codes from other
chapters may be used in conjunction with chapter 15
codes to further specify conditions. Should the provider
document that the pregnancy is incidental to the
encounter, then code Z33.1 Pregnant state, incidental,
should be used in place of any chapter 15 codes. It is the
provider’s responsibility to state that the condition being
treated is not affecting the pregnancy.
Since the 7th character extender is required on the codes,
the dummy placeholders must be used along with the
codes. For example, if a woman with a single gestation
6
is seen for a suspected chromosomal abnormality in the
fetus, it would be coded to O35.1xx1.
In instances where 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 to the trimester in which the
complications developed.
UnitedHealthcare
© 2013 AAPC. All rights reserved.
111213
Module 13
Pregnancy
For routine prenatal visits in the outpatient setting when
there are no complications, a code from category Z34,
Encounter for supervision of normal pregnancy, should
be used as the first-listed diagnosis. These codes should
not be used in conjunction with chapter 15 codes.
In many cases in this chapter, multiple codes are also
necessary to code a complete diagnosis. For example,
a woman in her second trimester with a group A strep
kidney infection would be coded with O23.01 Infections of kidney in pregnancy, second trimester and B95.0
Streptococcus, group A, as the cause of disease classified
elsewhere.
Diseases and Disorders in Pregnancy
Ectopic Pregnancy
An ectopic pregnancy occurs when there is an abnormal
implantation of a fertilized ovum outside of the uterine
cavity, most often referred to as a tubal pregnancy.
Approximately 90% of all ectopic pregnancies occur
in the fallopian tubes. To code ectopic pregnancies in
ICD-10-CM you need to know:
• location of pregnancy
Abdominal pregnancy
O00.0
Tubal pregnancy
O00.1
Ovarian pregnancy
O00.2
Other ectopic pregnancy
O00.8
Ectopic pregnancy unspecified
O00.9
Abortion
An abortion is the term used to describe a termination of
pregnancy before the fetus has reached a viable age. The
term abortion is a medical term used to denote any type
of termination of pregnancy. Many use the term miscarriage to describe a spontaneous abortion. A spontaneous
abortion is one that occurs on it’s own due to abnormalities of the embryo or fetus. Symptoms can include
vaginal bleeding, rhythmic uterine cramping, continual
backache, and a feeling of pressure in the pelvic area.
© 2013 AAPC. All rights reserved. 111213
To code abortions in ICD-10-CM you need to know:
•
•
•
•
type
complications
complete vs incomplete
stage of gestation
Missed abortion
O02.1
Delayed or excessive hemorrhage following O03.1
incomplete spontaneous abortion
Unspecified complication following
incomplete spontaneous abortion
O03.30
Incomplete spontaneous abortion without
complication
O03.4
Delayed or excessive hemorrhage following O03.6
complete or unspecified abortion
Unspecified complication following
complete or unspecified spontaneous
abortion
O03.80
Delayed or excessive hemorrhage following O04.6
induced termination of pregnancy
Genital tract and pelvic infection
following failed attempted termination of
pregnancy
O07.0
Gestational Diabetes
This disorder develops during the latter part of pregnancy and the symptoms usually disappear at the end
of pregnancy. Women who have gestational diabetes
have a higher possibility of developing it with subsequent pregnancies. Gestational diabetes is an inability to
metabolize carbohydrates, with resultant hyperglycemia.
Factors that increase the risk of developing gestational
diabetes include:
•
•
•
•
obesity
maternal age over 30 years
history of birthing large babies
family history of diabetes
UnitedHealthcare
www.aapc.com
7
Pregnancy
Module 13
• previous, unexplained stillborn birth
• previous birth with congenital defects
In order to code gestational diabetes in ICD-10-CM you
need to know the following:
• trimester
• associated complications
• type
O10.013
Pre-existing hypertensive heart disease
complicating pregnancy, third trimester
O10.113
Pre-existing hypertensive chronic kidney
disease complicating pregnancy, third
trimester
O10.213
Pre-existing hypertensive heart and
chronic kidney disease complicating pregnancy, third trimester
O10.313
Pre-existing hypertension with preeclampsia, third trimester
O11.3
Gestational edema, third trimester
O12.03
Pre-existing diabetes mellitus, type 2, in
pregnancy, second trimester
O24.112
Unspecified pre-existing diabetes mellitus
in pregnancy, second trimester
O24.312
Gestational diabetes mellitus in childbirth
diet controlled
O24.420
Other pre-existing diabetes mellitus in
pregnancy, second trimester
O24.812
Gestational proteinuria, third trimester
O12.13
Unspecified diabetes mellitus in pregnancy, second trimester
O24.912
Gestational edema with proteinuria, third
trimester
O12.23
Gestational [pregnancy-induced] hypertension without significant proteinuria,
third trimester
O13.3
Mild to moderate pre-eclampsia, third
trimester
O14.03
Severe pre-eclampsia, third trimester
O14.13
According to the guidelines, code Z79.4, Long-term
(current) use of insulin, should not be assigned with
codes from subcategory O24.4.
Hypertension in Pregnancy
Gestational hypertension is the development of hypertension during pregnancy, after 20 weeks gestation.
The hypertension resolves typically after the pregnancy
ends. Hypertension during pregnancy can also lead to
preeclampsia which is hypertension with proteinuria or
edema or to the most severe form of hypertension which
is eclampsia.
In order to code hypertension in pregnancy documentation must include:
• if hypertension was pre-existing
• trimester
• complications
8
Pre-existing essential hypertension
complicating pregnancy, third trimester
Anatomy and Pathophysiology for ICD-10
Codes from Chapter 15 (O00-O99A) require the use of
an additional code from category Z3A. Weeks of gestation, to identify the specific week of the pregnancy.
These codes are for use, only on the maternal record, to
indicate the weeks of gestation of the pregnancy.
Code first complications of pregnancy, childbirth, and
the puerperium (O00-O9A).
Weeks of gestation of pregnancy not
specified
UnitedHealthcare
Z3A.00
© 2013 AAPC. All rights reserved.
111213
Module 13
Pregnancy
Less than 8 weeks gestation of pregnancy
Z3A.01
30 weeks gestation of pregnancy
Z3A.30
8 weeks gestation of pregnancy
Z3A.08
31 weeks gestation of pregnancy
Z3A.31
9 weeks gestation of pregnancy
Z3A.09
32 weeks gestation of pregnancy
Z3A.32
10 weeks gestation of pregnancy
Z3A.10
33 weeks gestation of pregnancy
Z3A.33
11 weeks gestation of pregnancy
Z3A.11
34 weeks gestation of pregnancy
Z3A.34
12 weeks gestation of pregnancy
Z3A.12
35 weeks gestation of pregnancy
Z3A.35
13 weeks gestation of pregnancy
Z3A.13
36 weeks gestation of pregnancy
Z3A.36
14 weeks gestation of pregnancy
Z3A.14
37 weeks gestation of pregnancy
Z3A.37
15 weeks gestation of pregnancy
Z3A.15
38 weeks gestation of pregnancy
Z3A.38
16 weeks gestation of pregnancy
Z3A.16
39 weeks gestation of pregnancy
Z3A.39
17 weeks gestation of pregnancy
Z3A.17
40 weeks gestation of pregnancy
Z3A.40
18 weeks gestation of pregnancy
Z3A.18
41 weeks gestation of pregnancy
Z3A.41
19 weeks gestation of pregnancy
Z3A.19
42 weeks gestation of pregnancy
Z3A.42
20 weeks gestation of pregnancy
Z3A.20
Z3A.49
21 weeks gestation of pregnancy
Z3A.21
Greater than 42weeks gestation of
pregnancy
22 weeks gestation of pregnancy
Z3A.22
23 weeks gestation of pregnancy
Z3A.23
Comprehensive Medical Terminology (Fourth Edition) by
Betty Davis Jones.
24 weeks gestation of pregnancy
Z3A.24
Stedman’s Medical Dictionary, 28th edition
25 weeks gestation of pregnancy
Z3A.25
Bates’ Pocket Guide to Physical Examination and History
Taking, Third Edition (Lynn S. Bickley-Lippincott)
26 weeks gestation of pregnancy
Z3A.26
27 weeks gestation of pregnancy
Z3A.27
28 weeks gestation of pregnancy
Z3A.28
29 weeks gestation of pregnancy
Z3A.29
© 2013 AAPC. All rights reserved. 111213
Sources
UnitedHealthcare
www.aapc.com
9