2018 ICD-10-CM Changes to Obstetric and Perinatal Codes

By CodingStrategies on September 15th, 2017

This time every year the diagnosis coding changes are published and as expected, there are some significant changes.  In this article we will review the changes to obstetric and perinatal codes. 

 

  • Additional codes have been added to the tubal and ovarian pregnancy codes to specify laterality. 
    • O00.10 Tubal pregnancy without intrauterine pregnancy (old code)
      • O00.101 Right tubal pregnancy without intrauterine pregnancy (new code)
      • O00.102 Left tubal pregnancy without intrauterine pregnancy (new code)
      • O00.109 Unspecified tubal pregnancy without intrauterine pregnancy (new code)
    • O00.11 Tubal pregnancy with intrauterine pregnancy
      • O00.111 Right tubal pregnancy with intrauterine pregnancy (new code)
      • O00.112 Left tubal pregnancy with intrauterine pregnancy (new code)
      • O00.119 Unspecified tubal pregnancy with intrauterine pregnancy (new code)
    • O00.20 Ovarian pregnancy without intrauterine pregnancy (old code)
      • O00.201 Right ovarian pregnancy without intrauterine pregnancy
      • O00.202 Left ovarian pregnancy without intrauterine pregnancy
      • O00.209 Unspecified ovarian pregnancy without intrauterine pregnancy
    • O00.21 Ovarian pregnancy with intrauterine pregnancy
      • O00.211 Right ovarian pregnancy with intrauterine pregnancy
      • O00.212 Left ovarian pregnancy with intrauterine pregnancy
      • O00.219 Unspecified ovarian pregnancy with intrauterine pregnancy

 

  • New codes have been created to describe abnormalities of the fetal heart rate or rhythm.  These codes have been added to O36.8 Maternal Care for other specified fetal problems. 
    • O36.83 Maternal Care for abnormalities of the fetal heart rate or rhythm
      • O36.831 Maternal Care for abnormalities of the fetal heart rate or rhythm, first trimester
      • O36.832 Maternal Care for abnormalities of the fetal heart rate or rhythm, second trimester
      • O36.833 Maternal Care for abnormalities of the fetal heart rate or rhythm, third trimester
      • O36.839 Maternal Care for abnormalities of the fetal heart rate or rhythm, unspecified trimester

 

  • The codes for antenatal screening have been expanded to include specific reasons for screening exams. Currently code Z36 Encounter for antenatal screening of mother is assigned for all screening OB ultrasounds but beginning October 1, 2017 this will no longer be a valid code.  The new codes are:
    • Z36.0 Encounter for antenatal screening for chromosomal abnormalities
    • Z36.1 Encounter for antenatal screening for raised alphafetoprotein level (encounter for antenatal screening for elevated maternal serum alphafetoprotein level)
    • Z36.2 Encounter for other antenatal screening follow-up (non-visualized anatomy on previous scan)
    • Z36.3 Encounter for antenatal screening for malformations (screening for suspected anomaly)
    • Z36.4 Encounter for antenatal screening for fetal growth retardation (intrauterine growth restriction (IUGR)/small for dates)
    • Z36.5 Encounter for antenatal screening for isoimmunization
    • Z36.8 Encounter for other antenatal screening (requires 5th digit)
      • Z36.81 Encounter for antenatal screening for hydrops fetalis
      • Z36.82 Encounter for antenatal screening for nuchal translucency
      • Z36.83 Encounter for fetal screening for congenital cardiac abnormalities
      • Z36.84 Encounter for antenatal screening for fetal lung maturity
      • Z36.85 Encounter for antenatal screening for Streptococcus B
      • Z36.86 Encounter for antenatal screening for cervical length (screening for risk of pre-term labor)
      • Z36.87 Encounter for antenatal screening for uncertain dates
      • Z36.88 Encounter for antenatal screening for fetal macrosomia (screening for large-for-dates)
      • Z36.89 Encounter for other specified antenatal screening
      • Z36.8A Encounter for antenatal screening for other genetic defects
    • Z36.9 Encounter for antenatal screening unspecified

With the additional level of detail required to assign the appropriate diagnosis codes, now is the time to review your physician’s documentation to determine if the information is routinely documented and develop a plan to ensure all the necessary information is included in the patient’s medical record.  It is also important to share with your physicians the changes that will impact their documentation practices so that they can revise their documentation practices to include