Health data standards and systems

Failure to progress is a common occurance in pregnant women during labour. Often the doctors are not more specific in the documentation other than to document failure to progress. Can you please advise of the correct code to assign for failure to progress?

Presently, some hospitals are assigning O62.2 Other uterine inertia. However, I am unable to find an index entry to support the assignment of this code (as there is no look up for failure to progress specifically). It seems that the correct code might be in fact O62.9 Abnormality of forces of labour, unspecified or O62.8 Other abnormalities of forces of labour.

NCCH query Q1112 supports the assignment of a code from O62 block, but does not specify the use of O62.2 for failure to progress.

Perhaps a specific index entry for failure to progress is necessary, especially if the correct code is O62.2?

This query was originally published in the 2008-09 June VICC queries database as follows:

The VICC referred this query to the NCCH who provided the following advice"

"The NCCH agrees that failure to progress in labour is a description rather than a diagnostic term, therefore coders should assign a code for the underlying condition resulting in failure to progress. Underlying causes may include cephalopelvic disproportion, malpresentation, inefficient uterine action (primary uterine inertia or secondary uterine inertia), cervical dystocia, maternal exhaustion etc.

In the absence of documentation of an underlying cause for failure to progress clinical advice indicates that the correct code to assign is O62.9 Abnormalities of forces of labour, unspecified.

The NCCH will consider improvements to the Alphabetic Index for failure to progress in labour for a future edition of ICD-10-AM."

The VICC notes this advice was published in the March 2009 Volume 15 Number 4 10-AM Commandments.

The Coding Matters advice has been superseded. For Eighth edition advice on coding of failure to progress refer to ACCD Coding rules released 15 March 2014 titled Failure to progress in first or second stage:

[Q: There has been confusion regarding the clinical meaning of "failure to progress in 1st stage" or "failure to progress in 2nd stage" of labour. How do you code these conditions?
A: Failure to progress (FTP) is a general term that may indicate protracted/prolonged cervical dilation or fetal descent or complete arrest/cessation of cervical dilation or fetal descent.

FTP in labour may be caused by:
- fetal size/malpresentation
- pelvic size/shape/inadequacy
- abnormal uterine contractility

Failure/to/ progress (in labour) NEC is classified to O62.9 Abnormality of forces of labour, unspecified as per the index pathway below:
Failure, failed
- to
- - progress (in labour) NEC O62.9

Note that O62.9 is a ‘not elsewhere classified’ code, so where documentation specifies the cause of the FTP, code the cause instead of O62.9.

The clinical scenarios cited (FTP 1st stage and FTP 2nd stage) do not specify any cause for the FTP. Therefore O62.9 Abnormality of forces of labour, unspecified should be assigned in both of these incidences.

Where prolonged labour (stage one or stage two) is documented with failure to progress, also assign an appropriate code from O63 Long labour.

(See also Coding Rules: Failed trial of labour and failure to progress).

Note: This query has been retired following retirement of Coding Rules Q2725 Failure to progress in first or second stage of labour and Q2722 Failed trial of labour and failure to progress. VICC notes the Index entry Failure, failed/to/progress (in labour) (no underlying cause) NEC/underlying cause identified - see condition was updated in Eleventh Edition.