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I have been working on an e-learning program for ICD-10-PCS, which allowed me to review coding conventions and guidelines for Section 1 – Obstetrics. Because most of my focus since attending the American Health Information Management Association (AHIMA) ICD-10 Trainer Workshops has been on ICD-10-CM and the Medical and Surgical Section of ICD-10-PCS, I had forgotten much of what I learned related to the other sections in ICD-10-PCS – including what I learned about obstetrics procedure coding.
Since even those who are working on ICD-10 products forget new coding concepts that we don’t encounter daily, I thought it might be helpful to review this section. However, before discussing guidelines and some tips for coding of obstetrics services, first I want to review the official resources available to coders.
ICD-10-PCS Resources
In June, the 2013 ICD-10-PCS Draft was made available for download on the Centers for Medicare & Medicaid (CMS) website. Available downloads include:
2013 Official ICD-10-PCS Coding Guidelines for Obstetrics
There are limited coding guidelines currently available for ICD-10-PCS. In fact, only the Medical and Surgical section and Obstetrics section have any guidelines at all. For the Obstetric section, the available guidelines include a single guideline related to products of conception and a single guideline related to procedures following delivery or abortion. These guidelines are:
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.
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.
Section 1 – Obstetrics
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 three 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.
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 non-biological 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 these 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 Cesarean deliveries and vaginal deliveries in which the use of forceps or vacuum extraction is required.
Abortion coding tips are as follows:
Delivery coding tips are as follows:
Extraction coding tips are as follows:
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 also are used in the Medical and Surgical section. Learning the definitions of those 10 root operations 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 the Medical and Surgical section as well. In the process of learning ICD-10-PCS Obstetrics coding, coders also will become familiar with the format of the tables and will be able to learn how to easily use these tables to construct a code.
About the Author
Lauri Gray, RHIT, CPC, has worked in the health information management field for 30 years. She began her career as a health records supervisor in a multi-specialty clinic. Following that she worked in the managed care industry as a contracting and coding specialist for a major HMO. Most recently she has worked as a clinical technical editor of coding and reimbursement print and electronic products. She has also taught medical coding at the College of Eastern Utah. Areas of expertise include: ICD-10-CM, ICD-10-PCS, ICD-9-CM diagnosis and procedure coding, physician coding and reimbursement, claims adjudication processes, third-party reimbursement, RBRVS and fee schedule development. She is a member of the American Academy of Professional Coders (AAPC) and the American Health Information Management Association (AHIMA).
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