Reporting Complications in Pregnancy When No Specific Codes Exists
One challenge for ICD-10-CM code selection for MFM is the presentation of symptoms or conditions for which a precise diagnosis code doesn’t exist. ICD-10-CM offers several categories and subcategories from which to choose. They are:
O09.89- Supervision of other high risk pregnancies
O26.89- Other specified pregnancy related conditions
O36.89- Maternal care for other specified fetal problems
O99 Other maternal diseases classifiable elsewhere but complicating pregnancy, childbirth and the puerperium
O09.89-
This subcategory should be the primary diagnosis when a patient is seen for a scheduled antepartum visit and they are at high risk for a condition, for which there is not a specific “high-risk” code in the other parts of the O09 category.
Example:
The patient has a history of gestational hypertension in a previous pregnancy. There is no indication of gestational hypertension yet in this pregnancy, which is in the 2nd trimester.
Primary Diagnosis: O09.892; Secondary Diagnosis: Z87.59
O26.89-
This subcategory should be used when a patient presents with a condition that is likely caused by or related to the pregnancy, but for which there is not a specific code.
Example:
The patient presents in the 2nd trimester with complaints of bilateral lower abdominal and low back pain. The physician attributes the symptoms to pregnancy-related musculoskeletal changes.
Primary Diagnosis: O26.892; Secondary Diagnoses: R10.30, M54.5
O36.89- -
This subcategory should be used when there is a fetal issue, for which a specific code does not exist.
Example:
In the third trimester, a patient presents for a regular visit for her singleton pregnancy. During the encounter, routine antenatal screening indicates that there are abnormalities in the fetal heart rate.
Primary Diagnosis: O36.8930
O99
This category is to be used when the patient presents with a condition affecting their pregnancy. In most cases, this will be a condition that pre-dated the pregnancy, but there is not a code that describes that pre-existing condition in pregnancy (such as hypertension or Type I or Type II diabetes).
Example:
A patient in the 2nd trimester presents for a consultation regarding the management of her Crohn’s disease in pregnancy.
Primary Diagnosis: O99.612; Secondary Diagnosis: K50.90
O99 has several different categories for diseases affecting pregnancy, grouped based on the organ system affected. If the patient presents with a condition not associated with one of the organ systems listed under O99 (e.g. Systemic lupus (M32.9)), then the primary diagnosis is O99.89 Other specified diseases and conditions complicating pregnancy, childbirth and the puerperium.