Being a medical coder, I feel coding multiple ICD 10 codes is very complicated in diagnosis coding. Sequencing ICD 10 codes becomes very important when we are coding multiple diagnosis codes.

Since we have very specific codes in ICD 10, the frequency of using multiple diagnosis codes has increased. Even in 2019, we will be having some new specific ICD 10 codes.

Multiple ICD 10 codes are used in coding injuries like fracture, hypertensive renal heart disease, followup & Aftercare ICD 10 codes, pregnancy complication codes etc.

I myself feel that coding for initial, subsequent encounter & sequela for fracture has been the most discussed topic every-time. Still it is creating lot of coding errors among coders. But, today we will focus more on the coding errors done during the pregnancy complication codes.

Yes, Chapter 15 codes of Pregnancy complications has created lot of complication for medical coders. So, let us checkout what are the basic and silly errors done by medical coders.

Table of Contents

Incorrect use of Z3A category codes

Many coders are still not following the ICD 10 coding guideline for Z3A category. Last year, there was a new update for Z3A category.

Z3A codes should not be used along with Pregnancy with abortive outcome (O00-O08) codes. It is clearly mention below the Z3A category codes, that these codes should be used along with O09-O9A ICD 10 codes only.

Codes in category Z3A, Weeks of gestation are not applicable, and should not be assigned if the pregnancy is outside of the uterus or otherwise nonviable (categories O00-O02).

Use of Normal and Complicated codes together

Whenever a patient comes for a routine outpatient prenatal visits, then it should be reported with supervision of normal pregnancy Z34 codes. These codes should be reported only when the patient has no complications.

Never use a pregnancy complication codes along with Z34 series codes. A normal supervision and a pregnancy complication code cannot be used together as per coding guidelines. It is very simple, if it is a normal routine visit, then there should be no complication present.

Sequencing of Pregnancy codes with other chapter codes

Sequencing is always a big headache for medical coders. But, when you are coding a pregnancy chart then a codes from chapter 15 will always have high priority and should be sequenced primary. All other chapter codes should be added as secondary codes then.

Hence, the chapter 15 ‘O’ codes should be sequenced as primary diagnosis followed by secondary diagnosis codes from other chapters.

Correct use of First listed or Principal diagnosis

Medical coders are still not aware about importance of Primary or First listed diagnosis. This has increased lot of coding errors in pregnancy codes.

Always use the encounter Z codes like Z34 category, as Primary diagnosis. Similarly, if any complication is present in pregnancy, use ‘O’ codes as primary diagnosis followed by other secondary diagnosis.

Outcome of Delivery ICD 10 codes

These codes are included in Z37 category. Outcome of delivery codes should be used only when the patient delivers in the hospital. Fourth characters indicate both whether the outcome was single or multiple and whether liveborn or stillborn. For multiple births with more than twins, additional characters indicate the number of outcomes (e.g., triplets, quadruplets) and whether they were all liveborn, some liveborn, or all stillborn. These codes are used only on the mother’s record, not the record of the newborn, and are assigned only for the episode of care during which delivery occurred. No code from category Z37 is assigned when delivery occurs outside the hospital prior to admission.

References:

http://www.e-mds.com/revenue-cycle-management-age-icd-10-primer-ob-gyn

http://www.contemporaryobgyn.net/modern-medicine-feature-articles/icd-10-coding-pregnancy-complications

http://www.hcpro.com/HIM-302150-865/Pregnancy-codes-growing-in-ICD10CM.html

http://blog.himaginesolutions.com/icd-10-quick-tips-ob/gyn-episodes-of-care-and-complications