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ICD-10-PCS Coding Tips for Obstetrics

By Lauri Gray, CPC, RHIT
November 06, 2012

The Obstetrics Section is one of the smaller sections in ICD-10-PCS. It contains a single Body System value – Pregnancy (0), 12 Root Operation values, and 3 Body Part values – Products of Conception (0), Products of Conception, Retained (1), and Products of Conception, Ectopic (2). Because there is only one Body System and 12 Root Operations, there are only 12 Tables available in the Obstetrics Section from which to construct procedure codes. In addition, there are only limited guidelines available for the Obstetric Section. The currently available guidelines include a single guideline related to products of conception and a single guideline related to procedures following delivery or abortion.

Obstetrics Root Operations

The 12 Root Operations and their definitions are provided in the table below.

Root Operation

Definition

Abortion (A)

Artificially terminating a pregnancy

Change (2)

Taking out or off a device from a body part and putting back an identical or similar device in or on the same body part without cutting or puncturing the skin or a mucous membrane

Delivery (E)

Assisting the passage of the products of conception from the genital canal

Drainage (9)

Taking or letting out fluids and/or gases from a body part

Extraction (D)

Pulling or stripping out or off all or a portion of a body part by the use of force

Insertion (H)

Putting in a nonbiological appliance that monitors, assists, performs, or prevents a physiological function but does not physically take the place of a body part

Inspection (J)

Visually and/or manually exploring a body part

Removal (P)

Taking out or off a device from a body part, region or orifice

Repair (Q)

Restoring, to the extent possible, a body part to its normal anatomic structure and function

Reposition (S)

Moving to its normal location, or other suitable location, all or a portion of a body part

Resection (T)

Cutting out or off, without replacement, all of a body part

Transplantation (Y)

Putting in or on all or a portion of a living body part taken from another individual or animal to physically take the place and/or function of all or a portion of a similar body part


It should be noted that only two of the Root Operations are unique to Obstetrics – Abortion and Delivery. As with all Root Operations, Abortion and Delivery have precise definitions that must be applied to ensure that the correct code is assigned. The Root Operation Extraction is also important because it is used to report all Cesarean deliveries and vaginal deliveries where the use of forceps or vacuum extraction is required.

Obstetrics Coding Guidelines

These two currently available guidelines are as follows:

1. Products of conception

ICD-10-PCS Coding Guideline C1

Procedures performed on the products of conception are coded to the Obstetrics section. Procedures performed on the pregnant female other than the products of conception are coded to the appropriate root operation in the Medical and Surgical section.

Example: Amniocentesis is coded to the products of conception body part in the Obstetrics section. Repair of obstetric urethral laceration is coded to the urethra body part in the Medical and Surgical section.

2. Procedures following delivery or abortion

ICD-10-PCS Coding Guideline C2

Procedures performed following a delivery or abortion for curettage of the endometrium or evacuation of retained products of conception are all coded in the Obstetrics section, to the root operation Extraction and the body part Products of Conception, Retained. Diagnostic or therapeutic dilation and curettage performed during times other than the postpartum or post-abortion period are all coded in the Medical and Surgical section, to the root operation Extraction and the body part Endometrium.

Obstetrics Coding Tips

Understanding the root operations definitions and guidelines is the key to assigning the correct ICD-10-PCS codes. Below are some additional coding tips to help with correct code selection for the root operations abortion, delivery, and extraction.

Abortion coding tips are as follows:

  • The Root Operation Abortion applies only to artificially terminated pregnancies
  • Do not report the Root Operation Abortion for manually assisted spontaneous abortion. Manually assisted spontaneous abortion is reported with the Root Operation Delivery (E).
  • Do not report the Root Operation Abortion for missed or incomplete abortion requiring suction and/or curettage of products of conception. Suction/curettage of nonviable products of conception is reported with the Root Operation Extraction (D).

Delivery coding tips are as follows:

  • The Root Operation Delivery applies only to manually-assisted vaginal delivery of the products of conception
  • The products of conception may be a full-term viable fetus or nonviable products of the conception
  • There is a single code that can be constructed from Table 10E, which is 10E0XZZ Delivery of Products of Conception, External Approach

Extraction coding tips are as follows:

  • The Root Operation Extraction applies to all Cesarean deliveries and to vaginal deliveries requiring the use of forceps, vacuum, or internal version
  • Cesarean deliveries are always reported with the Approach value 0 for open approach and require a qualifier to more specifically identify the Approach as Classical (0),  Low Cervical (1) or Extraperitoneal (2)
  • Vaginal extractions are always reported with the Approach value 7, Via Natural or Artificial Opening, and require a qualifier to specifically identify the type of assisted vaginal delivery as Low Forceps (3), Mid Forceps (4), High Forceps (5), Vacuum (6), Internal Version (7), or Other (8)

Summary

The Obstetrics Section is a good section with which to begin ICD-10-PCS training because of the relatively limited number of Root Operations and Tables. While there are two Root Operations that apply only to Obstetrics, the other 10 Root Operations are used in the Medical and Surgical Section. Learning the definitions of the 10 Root Operations that are common to both sections and learning how these definitions are applied in the Obstetrics Section, will help coders understand how they are used and applied in Medical and Surgical Section as well. In the process of learning ICD-10-PCS Obstetrics coding, coders will also become familiar with the format of the Tables and will be able to more easily learn how to use the Tables to construct a code.
 

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