Basics of Ectopic and Molar Pregnancies

An ectopic pregnancy (EP) is a condition in which a fertilized egg settles and grows in any location other than the inner lining of the uterus. The vast majority of ectopic pregnancies are so-called tubal pregnancies and occur in the Fallopian tube. In short Ectopic and molar pregnancies and other abnormal products of conception are classified to the following categories, with an additional code from category O08 when any complication occurs.

O00 Ectopic pregnancy

O01 Hydatidiform mole

O02 Other abnormal product of conception

With an ectopic pregnancy, the egg can attach under these sites within the pelvic organ:

Cervical
Ovarian
Ampullary
Cornual (interstitital)
Isthmic
Fimbrial

Most of the medical coders struggle to code pregnancy as well as abortion ICD 10 codes. Since, the codes are very specific, the coders needs to have very good knowledge about pregnancy and abortion. Below are few posts on abortion to improve your knowledge about them.

Coding guide for Abortion CPT codes

How to code Induced Abortion Perfectly in ICD 10

A molar pregnancy is a rare complication that happens when tissue inside the uterus becomes a mass or tumor. Molar pregnancies are also called gestational trophoblastic disease (GTD), hydatidiform mole or simply referred to as a “mole.”

The hydatidiform mole is a particular type of molar pregnancy and is classified separately (O01.-) in ICD-10-CM. All other molar pregnancies are included in code O02.0, Blighted ovum and nonhydatidiform mole.

We have learnt already about twin pregnancy procedure and diagnosis codes. Human chorionic gonadotropin (hCG) plays an important role in pregnancy.

Human chorionic gonadotropin (hCG) is a hormone produced in the body during pregnancy. In early pregnancy, the hCG level should double approximately every two to three days. A decrease in the hCG doubling time may be an indication of a miscarriage or ectopic pregnancy. Although the hCG blood level and pregnancy tests will be positive, the gestational sac will not be visible on ultrasound.

An ectopic pregnancy must be ruled out when the ultrasound does not demonstrate an intrauterine pregnancy; if it is ruled out, the miscarriage is confirmed. Assign code O02.81, Inappropriate change in quantitative human chorionic gonadotropin (hCG) in early pregnancy.

Table of Contents

ICD 10 codes for Ectopic Pregnancy

An ectopic pregnancy (O00.0-; O00.1-; O00.2-; O00.8-; and O00.9-) occurs when a fertilized ovum is implanted and develops anywhere outside the uterus. The fourth character indicates the extrauterine location of the ectopic pregnancy, and the fifth character indicates with or without intrauterine pregnancy. The sixth character for subcategories O00.1, Tubal pregnancy, and O00.2, Ovarian pregnancy, describes right, left, or unspecified tubal or ovarian pregnancy. The codes are as follows:

O00.00 Abdominal pregnancy without intrauterine pregnancy

O00.01 Abdominal pregnancy with intrauterine pregnancy

O00.101 Right tubal pregnancy without intrauterine pregnancy

O00.102 Left tubal pregnancy without intrauterine pregnancy

O00.109 Unspecified tubal pregnancy without intrauterine pregnancy

O00.111 Right tubal pregnancy with intrauterine pregnancy

O00.112 Left tubal pregnancy with intrauterine pregnancy

O00.119 Unspecified tubal pregnancy with intrauterine pregnancy

O00.201 Right ovarian pregnancy without intrauterine pregnancy

O00.202 Left ovarian pregnancy without intrauterine pregnancy

O00.209 Unspecified ovarian pregnancy without intrauterine pregnancy

O00.211 Right ovarian pregnancy with intrauterine pregnancy

O00.212 Left ovarian pregnancy with intrauterine pregnancy

O00.219 Unspecified ovarian pregnancy with intrauterine pregnancy

O00.80 Other ectopic pregnancy without intrauterine pregnancy

O00.81 Other ectopic pregnancy with intrauterine pregnancy

O00.90 Unspecified ectopic pregnancy without intrauterine pregnancy

O00.91 Unspecified ectopic pregnancy with intrauterine pregnancy

There are procedure codes used for coding ectopic pregnancy, which needs to fulfill the above medical necessity or ICD 10 codes.

59120, surgical treatment of ectopic pregnancy; tubal or ovarian, requiring salpingectomy and/or oophorectomy, abdominal or vaginal approach
59121, surgical treatment of ectopic pregnancy; tubal or ovarian without salpingectomy and/or oophorectomy
59130, surgical treatment of ectopic pregnancy; abdominal pregnancy
59136, surgical treatment of ectopic pregnancy; interstitial, uterine pregnancy with partial resection of uterus
59140, surgical treatment of ectopic pregnancy; cervical, with evacuation
59150, laparoscopic treatment of ectopic pregnancy, without salpingectomy and/or oophorectomy
59151, laparoscopic treatment of ectopic pregnancy, with salpingectomy and/or oophorectomy

ICD 10 and ICD 10PCS codes for Tubal Pregnancy

Tubal pregnancy is the most common type of ectopic pregnancy. Surgical procedures like salpingotomy and salpingostomy are performed for removing a tubal ectopic pregnancy. An ectopic pregnancy can also be removed by excision of the fallopian tube (salpingectomy) with the ectopic pregnancy intact.

In ICD 10 PCS, removal of ectopic pregnancy is classified to the obstetrics Section, body system “pregnancy,” and body part “product of conception, ectopic.” If the removal of the ectopic pregnancy is performed via salpingotomy or salpingostomy, the root operation is “Extraction”; if the procedure is performed via salpingectomy, the root operation is “Resection.”

O00.102 Left tubal pregnancy

10T24ZZ Laparoscopy with resection of ectopic tubal pregnancy

O00.101 Right tubal pregnancy

10T20ZZ + 0UB50ZZ Laparotomy, salpingectomy with removal of right tubal pregnancy and excision of portion of right fallopian tube

There are complication ICD 10 codes for ectopic and molar pregnancies as well. When the complication occurs during an episode of care for the purpose of treating the ectopic or molar pregnancy, a code from the O00 through O02 series is sequenced first, followed by a code from category O08.

When the patient is readmitted for a complication following treatment of an ectopic or molar pregnancy, assign a code from category O08 as the principal diagnosis. An additional code that describes the complication more specifically can be assigned as needed.

O00.101 + O08.0 Pelvic peritonitis following right ectopic tubal pregnancy (this admission)

O08.1 Hemorrhage following ruptured ectopic tubal pregnancy removed on previous admission