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

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Premature rupture of membranes and spontaneous abortion

Publication Date: September 2007

ICD 10 AM Edition: Fifth edition

Retired Date: 30/6/2013

Query Number: 2330

Patient presented with SROM and PV bleeding. Assessed and diagnosed with PROM at 19/40 weeks. Progressed to a normal vaginal delivery, babe deceased shortly after birth. Birth weight 300g. Retained placenta required manual removal in theatre. Histopathology of the placenta revealed chorioamnionitis.

Discharge summary lists the principal diagnosis as Premature Rupture of Membranes and Spontaneous abortion.

Should this be coded as a pregnancy with abortive outcome because the babe does not meet criteria for a livebirth (ACS1510) or as a livebirth as per ACS1517? ACS1511 does not appear to fit with this scenario, although the pregnancy did result in a live birth.

We have coded it as follows because PROM was listed first under PDX:
O42.11 PROM onset labour between 1-7 days later
O09.2 Duration of pregnancy 14-19 completed weeks
O60.1 Preterm labour with pre term delivery
Z37.0 Single live birth
O41.1 Infection of amniotic sac and membranes
O72.0 Third stage haemorrhage
plus relevant procedure codes

This coding does not fit any of the relevant standards, nor does it take into account the documentation of spontaneous abortion.

Search Details:
Relevant coding standards in Chapter 15

Response

In accordance with ACS 1510 Pregnancy with Abortive Outcome, because the babe is less than 20 weeks and less than 400 grams, the episode must be coded as an abortion. Therefore VICC suggests the following codes be assigned for the case cited:
O03.3 Spontaneous abortion, incomplete, with other and unspecified complications (because the chorioamnionitis is a specified complication)
O09.2 Duration of pregnancy 14-19 completed weeks
O60.1 Preterm labour with pre term delivery
Z37.0 Single live birth
O41.1 Infection of amniotic sac and membranes
O42.1x PROM onset labour after 24 hours (assign the appropriate code depending on the documentation)

Codes O60.1 and Z37.0 have been assigned because there is a livebirth outcome, by applying the principles in ACS 1511 Termination of pregnancy and NCCH Q695 Liveborn infant at 17 weeks published 2/12/1998.

O72.0 Third stage haemorrhage is not required because the haemorrhage is included in the abortion code.