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CHAPTER 12
CHAPTER-SPECIFIC GUIDELINES
(ICD-10-CM CHAPTERS 15-21)
Copyright © 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc.
Slide 1
Pregnancy, Childbirth, and
the Puerperium, Chapter 15
• O00-O99
• Any condition that occurs during
pregnancy, childbirth, or puerperium is
a complication
– Unless physician documents it neither:
• Affects the pregnancy
• Is affected by the pregnancy
Copyright © 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc.
Slide 2
Sequencing Priority
• Chapter 15 codes have sequencing
priority of codes from other chapters
• Z33.1, incidental pregnancy state, is
reported if the physician documents
incidental status
• Chapter 15 codes are only for mother’s
record
– Never newborn’s record
Copyright © 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc.
Slide 3
Routine Prenatal Visits
• Routine outpatient prenatal visits with
no complications = Z34 category code
– First listed
• Routine high-risk prenatal visits = O09
category code
– First listed
Copyright © 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc.
Slide 4
Outcome of Delivery
• Outcome of delivery
– Z37 category code
– Only reported once
– On mother’s record
Copyright © 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc.
Slide 5
Trimester and Time Periods
• Majority of codes, final character indicates
trimester
• Trimester calculated from last menstrual
period (LMP)
– First trimester: less than 14 weeks 0 days
– Second trimester: 14 weeks 0 days to less than
28 weeks 0 days
– Third trimester: 28 weeks 0 days until delivery
• Peripartum = last month of pregnancy to 5
months postpartum
• Postpartum = immediately after delivery to 6
weeks after delivery
Copyright © 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc.
Slide 6
Ectopic Pregnancy
• Fertilized ovum implants outside the
uterus
• Reported with category O00, based on:
– Location of pregnancy
• Such as: ovarian or tubal
• Complications associated with ectopic
pregnancy:
– Report category O08 code
Copyright © 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc.
Slide 7
Hydatidiform Mole
• Tumor of the placenta
– Secretes hormones
• Report with category O01
• Report complication with category O08
• Malignant, report D39.2
Copyright © 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc.
Slide 8
Hypertension in Pregnancy
• Pre-existing hypertension that
complicates the pregnancy, delivery, or
the five-month period after birth,
Category O10
– First-listed code
Copyright © 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc.
Slide 9
Fetal Conditions
• Category O35 and O36 report fetal
abnormalities that affect the care of
mother
• If fetal abnormality does not affect care
of mother, do not report O35 or O36
Copyright © 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc.
Slide 10
Diabetes Mellitus in Pregnancy
• Type 1 = little or no insulin is produced
– Controlled with insulin
– Report long-term use of insulin
• Type 2 = too little or the body cannot use the insulin
that is produced
– Controlled with diet, medications, and/or insulin
– May report long-term use of insulin
• Gestational diabetes develops in 2nd or 3rd trimester
in patient who did not have diabetes prior to
pregnancy
– Do not report long-term use of insulin
Copyright © 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc.
Slide 11
Certain Conditions Originating
in the Perinatal Period,
Chapter 16
• P00-P96
• Chapter 16 codes only on newborn’s record
– Z38 reports liveborn according to place of birth
and type of delivery
– First listed
• Does not report congenital malformation,
deformities, or abnormalities
– Rather report with Q00-Q99
Copyright © 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc.
Slide 12
Congenital Malformations,
Deformation, and Chromosomal
Abnormalities, Chapter 17
• Q00-Q99
• May be a first-listed or secondary diagnosis
• Sequence as secondary diagnosis with
category Z38 code
• Reported whenever condition is diagnosed
• Congenital = born with
• Physician must document abnormality
Copyright © 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc.
Slide 13
Symptoms, Signs, and Abnormal
Clinical and Laboratory Findings,
NEC, Chapter 18
• R00-R99
• Sign = objective evidence of disease
• Symptom = subjective observation
• Report symptoms only when no more
definitive diagnosis is available
• Example: Pt complains of pain right lower
quadrant. Diagnosis states acute
appendicitis.
– Do not report symptom of pain
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Slide 14
Injury, Poisoning, and Certain
Other Consequences of External
Causes, Chapter 19
• S00-T88
• Many codes have 7th characters
• A initial encounter
– Receiving active treatment for the injury
• D subsequent encounter
– Completed active treatment and is receiving
routine care during healing
• S sequela
– Direct result of injury, add S to injury code, not to
sequela code
Copyright © 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc.
Slide 15
Traumatic Fractures
• Fractures not indicated as
– Open or closed, report as closed
– Displaced or not displaced, report as displaced
• Assign 7th character
– A initial encounter for closed fracture
– B initial encounter for open fracture
– D subsequent encounter for fracture with routine healing
– G subsequent encounter for fracture with delayed healing
– K subsequent encounter for fracture with nonunion
– S sequela
(Cont’d…)
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Slide 16
Traumatic Fractures
(…Cont’d)
• Multiple fractures, sequence according to
severity
• If dislocation and fracture of same bone,
report only fracture
• Category M80 reports non-traumatic fracture
for patients with osteoporosis
– Even if injury by trauma
– Pathological fracture occurs due to disease or
weakness
Copyright © 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc.
Slide 17
Burns and Corrosions
• Thermal burns from heat source
– Except sunburn
• Corrosion burns due to chemicals
• Guidelines same for burns and corrosions
• Burns classified by depth:
– 1st erythema
– 2nd blistering
– 3rd full-thickness
(Cont’d…)
Copyright © 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc.
Slide 18
Burns and Corrosions
(…Cont’d)
• Sequence first
– Highest degree of burn >1%
• Multiple burns, same area
– Report only the highest degree burn
• Infected burns
– Use additional code for infection
• Late effects of burns
– Report with burn or corrosion code + 7th
character “S”
Copyright © 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc.
Slide 19
Adverse Effects, Poisoning,
Underdosing, and Toxic Effects
• T36-T65
• Combination codes that include
– Substance
– External cause
• Sequence these codes 1st
– Follow with code(s) that specify nature
Copyright © 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc.
Slide 20
Poisoning
• Assign code from categories T36-T50,
poisoning codes
– Report any associated intent
• Such as, accidental, intentional, etc.
– Report all manifestations of poisoning
• Such as, vomiting
Copyright © 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc.
Slide 21
Drug Adverse Effect or
Poisoning
• Adverse Effect: Occurs when drug is
taken correctly but patient has negative
response
• Poisoning: Occurs when drug is
incorrectly taken
Copyright © 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc.
Slide 22
Abuse, Neglect, or
Maltreatment
• Sequence first (T74.- or T76.-)
• Medical documentation states
– Abuse or neglect, code as confirmed
– Suspected, code as suspected
• Confirmed cases of abuse or neglect
– Report an assault code (X92-Y08) to
indicate physical injury
– Report perpetrator code (Y07)
Copyright © 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc.
Slide 23
Conclusion
CHAPTER 12
CHAPTER-SPECIFIC GUIDELINES
(ICD-10-CM CHAPTER 15-21)
Copyright © 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc.
Slide 24