Diagnosis and Medical Coding for High Risk Pregnancy

Diagnosis and Medical Coding for High Risk Pregnancy To capture pregnancy diagnosis codes correctly, documentation must specify the type and trimester of pregnancy, age of the mother as well as other related, present co-conditions in the mother.

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A high-risk pregnancy is one that poses a potential threat to a woman before or during pregnancy, or after delivery. Regular monitoring and early special care of both the baby and mother throughout the pregnancy period is the best strategy to prevent further complications. Medical coding for high-risk pregnancy is a complicated process, as physicians need to consider factors such as current and pre-existing conditions, trimester of pregnancy, age of the mother and all related, present co-conditions in the mother. To meet these complicated documentation tasks, most healthcare practices now rely on medical billing and coding outsourcing.

What Are the Risk Factors for High-risk Pregnancy?

Generally, a high-risk pregnancy may be the result of a medical condition that occurs before pregnancy. In some other cases, a medical condition that develops during pregnancy for either the mother or baby causes a pregnancy to become high risk. Some of the prominent factors that might contribute to a high-risk pregnancy include – 

Advanced maternal age - Pregnancy risks are higher for mothers aged 35 and older.

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Medical history - A prior C-section, low birth weight baby or preterm birth — birth before 37 weeks of pregnancy — might increase the risk in subsequent pregnancies.

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Overweight and obesity – According to the American Congress of Obstetricians and Gynecologists, more than one-half of all pregnant women in the United States are overweight or obese. Being obese increases the future risks for high blood pressure, gestational diabetes, stillbirth, neural tube defects, preeclampsia and cesarean delivery. In fact, several studies indicate that obesity can raise infants' risk of heart problems at birth by 15%.

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Multiple pregnancies - The risks are higher for women carrying twins or higher order multiples. Typical issues include preeclampsia, premature labor, and preterm birth.

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Lifestyle choices – The habit of smoking, drinking alcohol and using illegal drugs can put a pregnancy at risk.

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Existing health conditions – Health conditions such as high blood pressure and/or diabetes, or being HIV-positive can pose significant risk.

Developing Conditions May Affect Coding The medical coding rules may change for a patient depending on whether a condition was present before pregnancy, occurred during pregnancy period or is the result of a complication of pregnancy or if a new condition or injury develops for the mother. For instance, coding for hypertension (HTN) that develops during the pregnancy period (gestational HTN, O13.1 - O13.5) is quite different from hypertension that exists before pregnancy (unspecified pre-existing hypertension complicating pregnancy, O10.911- O10.913).

Healthcare providers while documenting hypertension (HTN) condition – must be careful enough to analyze when the condition developed and how it is related to pregnancy. In other words, simply documenting “HTN” in a pregnant patient is insufficient.

Supervising High-risk Pregnancy – Coding Rules The medical coding rules for high-risk pregnancy reported significant changes in the year 2017. The rules from 2017 ICD-10-CM Official Guidelines for Coding and Reporting include – 

Code category O09 – Supervision of high-risk pregnancy

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The above code category is intended for use only during the prenatal period.

For complications during the labor or delivery episode as a result of high-risk pregnancy, the codes below are assigned 

O60 - O77 - Complications of Labor and Delivery

However, if there are no complications, the codes below are assigned 

O80 - O82 - Encounter for full-term uncomplicated delivery

When a patient is pregnant, anything done for the mother may in turn affect the baby. Any specific condition(s), the mother had prior to her pregnancy may affect the healthcare providers decision making. Healthcare providers must always account for pre-existing conditions and its effect on pregnancy, and must be sure that they are coding correctly. For instance, if a woman with pre-existing asthma becomes pregnant, the provider must consider how the pregnancy affects the asthma, and vice versa. So, correct understanding of what specific prior conditions constitute is crucial in reporting these services accurately. Physicians can utilize the medical billing services provided by a reliable and established outsourcing provider in this regard.

Learn about Trimester Coding Codes for supervision of normal pregnancy (Z34.-) are used only for patients who have no conditions complicating maternal or obstetric care. Codes in category Z34 are sub-classified as 

Z34.0 - Encounter for supervision of normal first pregnancy

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Z34.00 - Encounter for supervision, unspecified trimester

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Z34.01 - Encounter for supervision, first trimester

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Z34.02 - Encounter for supervision, second trimester

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Z34.03 - Encounter for supervision, third trimester

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It’s not appropriate to use Z34.00 - Encounter for supervision of normal first pregnancy, unspecified trimester for every visit until the patient delivers, or for a patient who has pre-existing conditions or who develops conditions during her pregnancy.

The trimester is calculated from the first day of the patient’s last menstrual period 

First trimester, less than 14 weeks 0 days

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Second trimester, 14 weeks 0 days through less than 28 weeks 0 days

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Third trimester, 28 weeks 0 days until delivery

Providers while reporting circumstances for a patient must not only document the trimester but also the specific week of gestation. Use additional code from category Z3A (weeks of gestation) to identify the specific week of the pregnancy. The codes in the Z3A code category include 

Z3A.00 - Weeks of gestation of pregnancy not specified

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Z3A.01 - Less than 8 weeks gestation of pregnancy

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Z3A.08 - 8 weeks gestation of pregnancy

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Z3A.09 - 9 weeks gestation of pregnancy

From there, the codes increase one week at a time and reach up to 

Z3A.42 - 42 weeks gestation of pregnancy

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Z3A.49 - Greater than 42 weeks gestation of pregnancy

The age of a pregnant patient is an important factor. For instance, if a patient is below 16 years of age or above 35 years of age (or will be at the time of expected delivery), it is important to assign a high-risk code for “young” or “elderly mother” must be assigned.

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To have a healthy and successful pregnancy and delivery, women with highrisk pregnancies must receive extra care from a special team of health care providers. Managing obstetrics and gynecology medical billing and coding is much easier for obstetricians and gynecologists who partner with an experienced medical billing and coding service provider. With an experienced team of AAPC-certified coders and billing professionals, handling their coding and claim submission would be an easy task and would ensure appropriate reimbursement.

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