To capture pregnancy diagnosis codes correctly, documentation must specify the type and trimester of pregnancy, age of the mother as well as other related, present co-conditions in the mother.

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Diagnosis and
Medical Coding for
High Risk Pregnancy
2018
To capture pregnancy diagnosis codes correctly,
documentation must specify the type and trimester
of pregnancy, age of the mother as well as other
related, present co-conditions in the mother.
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A high-risk pregnancy is one that poses a potential threat to a woman before
or during pregnancy, or after delivery. Regular monitoring and early special
care of both the baby and mother throughout the pregnancy period is the
best strategy to prevent further complications. Medical coding for high-risk
pregnancy is a complicated process, as physicians need to consider factors
such as current and pre-existing conditions, trimester of pregnancy, age of
the mother and all related, present co-conditions in the mother. To meet
these complicated documentation tasks, most healthcare practices now rely
on medical billing and coding outsourcing.
What Are the Risk Factors for High-risk Pregnancy?
Generally, a high-risk pregnancy may be the result of a medical condition
that occurs before pregnancy. In some other cases, a medical condition that
develops during pregnancy for either the mother or baby causes a
pregnancy to become high risk. Some of the prominent factors that might
contribute to a high-risk pregnancy include –
 Advanced maternal age - Pregnancy risks are higher for mothers
aged 35 and older.
 Medical history - A prior C-section, low birth weight baby or preterm
birth — birth before 37 weeks of pregnancy — might increase the risk
in subsequent pregnancies.
 Overweight and obesity – According to the American Congress of
Obstetricians and Gynecologists, more than one-half of all pregnant
women in the United States are overweight or obese. Being obese
increases the future risks for high blood pressure, gestational diabetes,
stillbirth, neural tube defects, preeclampsia and cesarean delivery. In
fact, several studies indicate that obesity can raise infants' risk of
heart problems at birth by 15%.

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 Multiple pregnancies - The risks are higher for women carrying
twins or higher order multiples. Typical issues include preeclampsia,
premature labor, and preterm birth.
 Lifestyle choices – The habit of smoking, drinking alcohol and using
illegal drugs can put a pregnancy at risk.
 Existing health conditions – Health conditions such as high blood
pressure and/or diabetes, or being HIV-positive can pose significant
risk.
Developing Conditions May Affect Coding
The medical coding rules may change for a patient depending on whether a
condition was present before pregnancy, occurred during pregnancy period
or is the result of a complication of pregnancy or if a new condition or injury
develops for the mother. For instance, coding for hypertension (HTN) that
develops during the pregnancy period (gestational HTN, O13.1 - O13.5) is
quite different from hypertension that exists before pregnancy (unspecified
pre-existing hypertension complicating pregnancy, O10.911- O10.913).
Healthcare providers while documenting hypertension (HTN) condition –
must be careful enough to analyze when the condition developed and how it
is related to pregnancy. In other words, simply documenting “HTN” in a
pregnant patient is insufficient.
Supervising High-risk Pregnancy – Coding Rules
The medical coding rules for high-risk pregnancy reported significant
changes in the year 2017. The rules from 2017 ICD-10-CM Official
Guidelines for Coding and Reporting include –
 Code category O09 – Supervision of high-risk pregnancy

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The above code category is intended for use only during the prenatal period.
For complications during the labor or delivery episode as a result of high-risk
pregnancy, the codes below are assigned -
 O60 - O77 - Complications of Labor and Delivery
However, if there are no complications, the codes below are assigned -
 O80 - O82 - Encounter for full-term uncomplicated delivery
When a patient is pregnant, anything done for the mother may in turn affect
the baby. Any specific condition(s), the mother had prior to her pregnancy
may affect the healthcare providers decision making. Healthcare providers
must always account for pre-existing conditions and its effect on pregnancy,
and must be sure that they are coding correctly. For instance, if a woman
with pre-existing asthma becomes pregnant, the provider must consider how
the pregnancy affects the asthma, and vice versa. So, correct understanding
of what specific prior conditions constitute is crucial in reporting these
services accurately. Physicians can utilize the medical billing services
provided by a reliable and established outsourcing provider in this regard.
Learn about Trimester Coding
Codes for supervision of normal pregnancy (Z34.-) are used only for patients
who have no conditions complicating maternal or obstetric care. Codes in
category Z34 are sub-classified as -
 Z34.0 - Encounter for supervision of normal first pregnancy
 Z34.00 - Encounter for supervision, unspecified trimester
 Z34.01 - Encounter for supervision, first trimester
 Z34.02 - Encounter for supervision, second trimester
 Z34.03 - Encounter for supervision, third trimester

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It’s not appropriate to use Z34.00 - Encounter for supervision of normal first
pregnancy, unspecified trimester for every visit until the patient delivers, or
for a patient who has pre-existing conditions or who develops conditions
during her pregnancy.
The trimester is calculated from the first day of the patient’s last menstrual
period -
 First trimester, less than 14 weeks 0 days
 Second trimester, 14 weeks 0 days through less than 28 weeks 0 days
 Third trimester, 28 weeks 0 days until delivery
Providers while reporting circumstances for a patient must not only
document the trimester but also the specific week of gestation. Use
additional code from category Z3A (weeks of gestation) to identify the
specific week of the pregnancy. The codes in the Z3A code category include
-
 Z3A.00 - Weeks of gestation of pregnancy not specified
 Z3A.01 - Less than 8 weeks gestation of pregnancy
 Z3A.08 - 8 weeks gestation of pregnancy
 Z3A.09 - 9 weeks gestation of pregnancy
From there, the codes increase one week at a time and reach up to -
 Z3A.42 - 42 weeks gestation of pregnancy
 Z3A.49 - Greater than 42 weeks gestation of pregnancy
The age of a pregnant patient is an important factor. For instance, if a
patient is below 16 years of age or above 35 years of age (or will be at the
time of expected delivery), it is important to assign a high-risk code for
“young” or “elderly mother” must be assigned.

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To have a healthy and successful pregnancy and delivery, women with high-
risk pregnancies must receive extra care from a special team of health care
providers. Managing obstetrics and gynecology medical billing and coding is
much easier for obstetricians and gynecologists who partner with an
experienced medical billing and coding service provider. With an experienced
team of AAPC-certified coders and billing professionals, handling their coding
and claim submission would be an easy task and would ensure appropriate
reimbursement.