EmailACS 1521 Conditions Complicating Pregnancy
Publication Date: June 2012
ICD 10 AM Edition: Seventh edition
Retired Date: 30/6/2017
Query Number: 2684
Please find attached some examples of cases where pregnant women present to hospital with various medical complaints.
Scenario 1
Dyspnoea of Pregnancy
Is it correct to code this as:
O99.8 Other specified diseases and conditions complicating pregnancy, childbirth and the puerperium
R06.0 Dyspnoea
Following the Index:
Pregnancy
-complicated by
-- conditions in
--- R00-R99 O99.8
This is an example where the term “complicating” is not used in the record, but the discharge diagnosis has made the link to pregnancy.
None of the examples in ACS 1521 reflect the above scenario.
Scenario 2
Ax Likely ligamentous stretch
Patient 22/40 wks gestation presents to our delivery suite via ED and is assessed for her lower abdominal pain by O&G Reg.
Please advise on how to code this case and your reasons.
Scenario 3
Patient 39/40 wks gestation presents to Pregnancy Assessment and Review Day Stay after her Antenatal visit revealed headaches, oedema and a trace of protein. After examination, there was no evidence of PET or PIH.
Please advise on how to code this case.
Scenario 4 & Scenario 5
I have provided 2 scenarios where a pregnant lady has presented with a UTI. Some coders would use N39.0 UTI with Z34.x and others would use O23.4 UTI in pregnancy.
We are not sure what is meant by the following line In ACS1521; “Conditions that are known to occur commonly in pregnancy have specific codes in O20 – O29”. Does this mean we can code UTIs to O23.4 or does documentation need to say that the UTI is complicating or exacerbating pregnancy.
The only way to find a pregnancy related code through the Index is:
Infection
- urinary (tract) NEC N39.0
-- complicating pregnancy O23.4
Pregnancy
- complicated by
--- urinary (tract) O23.4
Yet the Tabular description is O23.4 Unspecified infection of urinary tract in pregnancy. It can get very confusing as to how the country would like these cases coded and I’m sure you would find inconsistencies, not to mention different DRGs and WIES values. It is important to review the way we code antenatal cases and how they are grouped before ABF commences.
We don’t understand why O codes without delivery would be all grouped to an Antenatal DRG when management can be for different conditions such as infections and hypertension etc.
Example:
Pdx N390, Z348
DRG L63B WIES 0.1453 (same-day) or 0.5717
Pdx O234
DRG O66Z WIES 0.1621 (same-day) or 0.4369
Scenario 1
Dyspnoea of Pregnancy
Is it correct to code this as:
O99.8 Other specified diseases and conditions complicating pregnancy, childbirth and the puerperium
R06.0 Dyspnoea
Following the Index:
Pregnancy
-complicated by
-- conditions in
--- R00-R99 O99.8
This is an example where the term “complicating” is not used in the record, but the discharge diagnosis has made the link to pregnancy.
None of the examples in ACS 1521 reflect the above scenario.
Scenario 2
Ax Likely ligamentous stretch
Patient 22/40 wks gestation presents to our delivery suite via ED and is assessed for her lower abdominal pain by O&G Reg.
Please advise on how to code this case and your reasons.
Scenario 3
Patient 39/40 wks gestation presents to Pregnancy Assessment and Review Day Stay after her Antenatal visit revealed headaches, oedema and a trace of protein. After examination, there was no evidence of PET or PIH.
Please advise on how to code this case.
Scenario 4 & Scenario 5
I have provided 2 scenarios where a pregnant lady has presented with a UTI. Some coders would use N39.0 UTI with Z34.x and others would use O23.4 UTI in pregnancy.
We are not sure what is meant by the following line In ACS1521; “Conditions that are known to occur commonly in pregnancy have specific codes in O20 – O29”. Does this mean we can code UTIs to O23.4 or does documentation need to say that the UTI is complicating or exacerbating pregnancy.
The only way to find a pregnancy related code through the Index is:
Infection
- urinary (tract) NEC N39.0
-- complicating pregnancy O23.4
Pregnancy
- complicated by
--- urinary (tract) O23.4
Yet the Tabular description is O23.4 Unspecified infection of urinary tract in pregnancy. It can get very confusing as to how the country would like these cases coded and I’m sure you would find inconsistencies, not to mention different DRGs and WIES values. It is important to review the way we code antenatal cases and how they are grouped before ABF commences.
We don’t understand why O codes without delivery would be all grouped to an Antenatal DRG when management can be for different conditions such as infections and hypertension etc.
Example:
Pdx N390, Z348
DRG L63B WIES 0.1453 (same-day) or 0.5717
Pdx O234
DRG O66Z WIES 0.1621 (same-day) or 0.4369
Response
VICC advises that if the documentation makes a link between the condition and the pregnancy it is appropriate to follow the various index entries linking the condition to the pregnancy. Examples of index entries that can be followed when a link is documented between the pregnancy and the condition include ' complicating pregnancy', 'of pregnancy', 'in pregnancy' and 'complicated by'.
VICC considers that of the examples provided, the documentation in scenario one makes a link between the dyspnoea and the pregnancy, thus enabling an 'O' code to be assigned. In all other scenarios VICC did not find evidence to support a link between the pregnancy and the condition but considers the documentation that the committee reviewed supports the assignment of Z34 Supervision of normal pregnancy as an additional diagnosis.
In regard to all episodes with an O code without a delivery code grouping to an antenatal DRG, this is because of the principles used in grouper development to group all antenatal episodes into one DRG.
VICC considers that of the examples provided, the documentation in scenario one makes a link between the dyspnoea and the pregnancy, thus enabling an 'O' code to be assigned. In all other scenarios VICC did not find evidence to support a link between the pregnancy and the condition but considers the documentation that the committee reviewed supports the assignment of Z34 Supervision of normal pregnancy as an additional diagnosis.
In regard to all episodes with an O code without a delivery code grouping to an antenatal DRG, this is because of the principles used in grouper development to group all antenatal episodes into one DRG.
