This page addresses follow-up questions and additional information pertinent to our webinar
Complex Obstetrics Coding Concepts.
** The coding information and guidance are valid at the time of publishing. Learners are encouraged to research
subsequent official guidance in the areas associated with the topic as they can change rapidly.
Q: Are the premature rupture of membranes codes based on the length of time between rupture and onset of labor or the time between rupture and delivery?
A: The codes are based on the time between rupture of membranes and onset of labor
Q: If the provider documents premature rupture of membranes but doesn’t say how long it was before the onset of delivery, can you use nursing documentation if it gives the time of rupture and the time labor began?
A: Yes, if that documentation is present, it can be used to specify the amount of time between the rupture and onset of labor. But if the documentation is not present, there is a code for PROM without mention of how long the membranes have been ruptured.
Q: Coding Clinic, 1st Quarter 2020: Page 20 gave advice to assign code O98.3- (Other infections with a predominantly sexual mode of transmission complicating pregnancy, childbirth and the puerperium) and code A60.09 (Herpesviral infection of other urogenital tract) to report a pregnant patient with a history of genital herpes. In the Joint Commission (TJC) Specifications Manual 2025A, the PC-02 measure has been updated to exclude cases “with active lesions or prodromal symptoms (i.e., vulvar pain or burning at delivery) that may indicate viral shedding,” in accordance with the American College of Obstetricians and Gynecologists (ACOG) recommendations (2020). What should a hospital do if a patient is on antivirals, has not had an outbreak in ten years, and has ZERO active lesions or prodromal symptoms? Per TJC guidance, that patient should not go to the OR for a cesarean delivery based on their herpes history, and there should be a fallout if they do. However, that patient will be removed from the measure entirely if coded as A60.9.
A: Coders should follow Coding Clinic advice and assign codes O98.3- and A60.09 since this represents official coding advice. Most quality reporting stakeholders are aware that this represents a conflict with how TJC is using the data and some suspect TJC will roll back the use of code A60.09 for identifying only active infection.
Q: Why should blood transfusions be coded on maternal records?
A: Blood transfusion data is used for quality measure reporting in PC-07 and should be coded on maternal records.
Q: Our electronic health record does not allow for us to easily identify the route of administration for blood transfusions, so we have opted not to code them. Since blood transfusion data is collected for quality measures, how do you recommend we code the body part for the blood transfusion code?
A: We recommend working with clinical staff to determine which approach is the most common practice and establishing a facility default policy. For example, after meeting with your clinical staff, it may be determined that most blood transfusions given to pregnant and postpartum patients is through a peripheral IV access. In this instance, it would be reasonable to develop an internal policy stating that when the route of transfusion administration cannot be determined (central vein vs. peripheral vein), then the body part default is peripheral vein based on common practice (Source: Coding Clinic, 3rd Quarter 2014, page 8).
We are looking for clarification on when to assign O26.8XX vs O99.891 for obstetric patients that present to the OB clinic. We are seeing patients present with conditions not documented by the provider as “pregnancy related”, or documented by the provider as “pregnant state, incidental”.
Examples we are seeing are #1 – N/V, sore throat, headache. #2 – CKD1 without documentation stating diagnosed prior to pregnancy.
Additionally, when an obstetric patient presents to the OB clinic, after 20 weeks’ gestation, with N/V, without diagnosis of hyperemesis gravidarum, does vomiting need to be documented as “excessive” to assign O21.2? What is the correct use of O21.9?
We recommend relying on index pathways within the Alphabetic Index and the default coding guideline (I.A.18.), which states, “A code listed next to a main term in the ICD-10-CM Alphabetic Index is referred to as a default code. The default code represents that condition that is most commonly associated with the main term or is the unspecified code for the condition. If a condition is documented in a medical record (for example, appendicitis) without any additional information, such as acute or chronic, the default code should be assigned.” For example, CKD in pregnancy without any additional information is classified to subcategory O26.83 based on indexing (Disease, diseased; kidney; complicating pregnancy – see Pregnancy, complicated by, renal disease). When referencing Pregnancy; complicated by; renal disease, the default code is O26.83-. Vomiting in pregnancy is indexed as Pregnancy; complicated by; vomiting” and the default code is O21.9.
on case study #4 why would the repair of the vagina be an open approach can you explain?
Case Study #4: Admission for a High-Risk
OB Condition
A 42-year-old G1P0 39-week patient presented for induction of labor
due to advanced maternal age. Labor was induced with Pitocin. The
patient delivered a liveborn infant over a high vaginal laceration.
© Haugen Consulting Group, Inc. 14
POA Description Code
N Obstetric high vaginal laceration alone O71.4
Single live birth Z37.0
39 weeks gestation Z3A.39
Delivery of Products of Conception, External
Approach
10E0XZZ
Repair Vagina, Open Approach
Hi Roberta, Yes, code D62 could also be reported to specify the anemia as acute blood loss anemia. Regards, The Haugen Academy Learning Team