Coding for Other Conditions in Pregnancy
Author(s): The Society for Maternal-Fetal Medicine (SMFM) Coding Committee; Brad Hart, MBA, MS, CPC, CPMA, COBGC.
Background: The ICD-10-CM diagnosis code book provides in Chapter 15 (codes O00-O9A) a broad variety of diagnoses related to pregnancy—both pregnancy-specific diagnoses and conditions that are complicated or exacerbated by the pregnancy. However, there will be occasions in which the patient has a diagnosis for which a pregnancy-specific code is not available. The exact code(s) to be used will depend on the condition.
Coding Tip: Chapter 15 includes a variety of options in the O99 category, “Other maternal diseases classifiable elsewhere, but complicating pregnancy, childbirth, and the puerperium.” There are separate subcategories within this category for several different conditions or organ systems. The user is to select the primary diagnosis from the relevant condition/organ system subcategory, and then assign a secondary diagnosis for the specific condition. The subcategories in this category are available in the PDF posted on this page.
If the patient has a condition that does not fall within any of these categories, then a code O99.891 Other specified diseases and conditions complicating pregnancy is selected as the primary diagnosis. Examples of this type of condition could include M32.9 Systemic lupus erythematosus or N18.9 Chronic kidney disease, or certain maternal congenital conditions identified in Chapter 17 (“Q” codes). These diagnoses would be reported as a secondary diagnosis, as appropriate.
If the patient has a condition that does not have a specific pregnancy-related diagnosis code, but the clinician believes that the condition is caused directly by the pregnancy, then report ICD-10-CM code O26.89-Other specified pregnancy related conditions, ______ trimester. Possible examples include R10.2 Pelvic and perineal pain or M54.50 Low back pain, unspecified, which are reported as a secondary diagnosis.