'Department of Health and Human services, Victoria, Australia'

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Accidents and injuries during pregnancy

Publication Date: December 2004

ICD 10 AM Edition: Fourth edition

Retired Date: 30/6/2010

Query Number: 1986

Scenario 1:
Obstetric patients present following motor vehicle accidents (MVAs), accidents in the home, workplace etc. They are seen by the O&G clinician, and CTG is performed to assess fetal wellbeing.
We code these episodes according to the 'Minor Trauma Coding Guidelines' (ICD Coding Newsletter - June 2001), as well as coding 'O99.8 Other specified diseases and conditions complicating pregnancy, childbirth and the puerperium' as the principal diagnosis.
That is, if a pregnant patient presents for observation, we would assign:
'O99.8 Other specified diseases and conditions complicating pregnancy, childbirth and the puerperium'
'Z04.1 Examination and observation following transport accident'
'V43.xx Car occupant injured in collision with car, pick-up truck or van'
'Y92.40 Roadway'
'U73.8 Other specified activity'

Is this correct?

Scenario 2:
Obstetrics patient presents with abdominal pain/strain following seatbelt injury, is assessed by obstetrics team, and CTG is performed.
We would assign:
'O99.8 Other specified diseases and conditions complicating pregnancy, childbirth and the puerperium'
'S39.8 Other specified injuries of abdomen, lower back and pelvis'
'V43.xx Car occupant injured in collision with car, pick-up truck or van'
'Y92.40 Roadway'
'U73.8 Other specified activity'
which groups to DRG 'O65B Oth Antenatal W Moderate/No Comp Diag'.

However, some HIMs are now not using O99.8, and using 'Z33 Pregnant state, incidental' as the last code. That is:
'S39.8 Other specified injuries of abdomen, lower back and pelvis'
'V43.xx Car occupant injured in collision with car, pick-up truck or van'
'Y92.40 Roadway'
'U73.8 Other specified activity'
'Z33 Pregnant state, incidental'
which groups to DRG 'X60C Injuries Age < 65'.

Is preceeding the injury code with O99.8 (as principal diagnosis) correct, or is Z33 as last diagnosis the correct option?

Response

This query was referred to the NCCH for advice.
Z33 Pregnant state, incidental should not be assigned if a patient requires obstetric observation or care (see ACS 1521 Conditions Complicating Pregnancy, Incidental pregnant state). Both scenario 1 and 2 state observation by obstetric clinicians and specialist obstetric procedures (CTG monitoring), therefore, Z33 Pregnant state, incidental should not be assigned for either of these scenarios.

The NCCH suggests the following codes for the cases cited:
1. Where an accident has occurred, no injuries are sustained but the patient is seen by the O & G clinician and CTG is performed:
Z04.1 Examination and observation following transport accident
Z34.x Supervision of normal pregnancy
With appropriate external cause, place of occurrence, activity and procedure codes.

2. Where injuries have resulted from an accident but there is no indication of a resulting problem with the pregnancy and the patient is seen by the O & G clinician and CTG is performed:
S39.8 Other specified injuries of abdomen, lower back and pelvis
Z34.x Supervision of normal pregnancy
With appropriate external cause, place of occurrence and activity codes followed by relevant procedure codes.

O99 Other maternal diseases classifiable elsewhere but complicating pregnancy, childbirth and the puerperium has an ‘excludes’ note for injury. To assign a code from O99, while indicating that the patient is receiving obstetric care, would contravene the exclusion note. In the second scenario, the codes from the injury chapter are sufficient to describe the injury and comply with the ‘excludes’ note.

In addition, the official WHO updates to ICD 10 for 2003 include complete code ranges for 'Pregnancy, complicated by, conditions in'. Codes from Chapter XIX Injury, poisoning and certain other consequences of external causes (S00 T98) are not included in these index entries.

This advice may change current coding practice.