1.   Rationale: Colp/o is the combining form referring to the vagina. As examples, colpocele (N81.5) and colpocystitis (N76.0) are medical conditions of the vagina.

2.   Rationale: According to ICD-10-CM guideline I.C.15.o.2, a postpartum complication is any complication occurring within the six-week period following delivery.

3.   Rationale: The postpartum period is also known as the puerperium or puerperal period.

4.   Rationale: According to the ICD-10-CM guidelines, codes in Chapter 15: Pregnancy, Childbirth, and the Puerperium (O00-O9A) have sequencing priority over codes from all other chapters in the ICD-10-CM code book.

5.   Rationale:

ICD-10-CM Alphabetic Index: Pregnancy > triplet > O30.10-.

In the Tabular List additional characters are required to indicate the number of placenta and the number of amniotic sacs. There is no documentation of placentas or amniotic sacs, so 0 for unspecified is reported as the 5th character.

The 6th character 3 is reported to indicate the 3rd trimester (trimesters are listed at the beginning of chapter 15 in the ICD-10-CM code book). The complete code is O30.103.

ICD-10-CM Alphabetic Index: Outcome of Delivery > multiple births > all liveborn > triplets Z37.51.

The last code indicates the weeks of gestation. Documentation indicates she delivered at her 32nd week.

ICD-10-CM Alphabetic Index: Pregnancy > Weeks of gestation > 32 weeks Z3A.32.

Verify code selection in the Tabular List.

6.   Rationale:

ICD-10-CM Alphabetic Index: Pregnancy > Complicated by > Spotting > O26.85-

Notes at the beginning of chapter 15 indicate that 21 weeks lies in the 2nd trimester.

Further review of the codes in this category show that 5th character 2 indicates second trimester, resulting in code O26.852.

At the beginning of chapter 15, under the notes, there is a reference to use an additional code from category Z3A, Weeks of gestation, to identify the specific week of the pregnancy.

ICD-10-CM Alphabetic Index: Pregnancy > Weeks of gestation > 21 weeks > Z3A.21.

Verify code selection in the Tabular List.

7.   Rationale:

ICD-10-CM Alphabetic Index: Abscess > Breast (acute) (chronic) (nonpuerperal) > Puerperal/ Postpartum/Gestational > which guides you to “see” Mastitis, obstetric, purulent.

ICD-10-CM Alphabetic Index: Mastitis (acute) (diffuse) (nonpuerperal) (subacute) > Obstetric > Purulent > Associated with > Puerperium > O91.12.

In the Tabular List, the description under O91.12 includes puerperal mammary abscess.

The puerperium is the period of six weeks or 42 days following childbirth.

8.   Rationale:

ICD-10-CM Alphabetic Index: Pregnancy > Ovarian > O00.20.

In the Tabular List, the 6th character 2 is selected to specify the left ovary.

ICD-10-CM guideline I.C.15.b.1 states to not assign codes from category Z34 with chapter 15 codes.

9.   Rationale:

ICD-10-CM Alphabetic Index: Diabetes, diabetic (mellitus) (sugar) > Gestational (in pregnancy) > Diet controlled > O24.410.

Verify code selection in the Tabular List.

ICD-10-CM guideline I.C.15.i states: “No other code from category O24, Diabetes mellitus in pregnancy, childbirth, and the puerperium, should be used with a code from O24.4.”

At the beginning of chapter 15 there is a reference to use additional code from category Z3A Weeks of gestation to identify the specific week of the pregnancy.

ICD-10-CM Alphabetic Index: Pregnancy > Weeks of gestation > 40 weeks > Z3A.40.

Verify code selection in the Tabular List.

ICD-10-CM guideline I.C.15.a.1 states chapter 15 codes have sequencing priority.

10. Rationale:

ICD-10-CM Alphabetic Index: Pregnancy > Ovarian > O00.20-. A 6^th character is required to identify laterality; 2 is assigned for the left ovary.

In the Tabular List, there is an instructional note to use an additional code from category O08 to identify any associated complication.

No complication is documented.

Verify code selection in the Tabular List.

11. Rationale:

ICD-10-CM Alphabetic Index: Diabetes, diabetic > Gestational > Insulin (and diet) controlled > O24.414.

In the Tabular List, the codes under subcategory O24.4- are chosen based on timing (in pregnancy, childbirth, or the puerperium) and whether the gestational diabetes is known to be diet or insulin controlled.

The 5th character 1 indicates gestational diabetes in pregnancy, and the 6th character 4 indicates insulin controlled.

This same guideline indicates code O24.414 includes insulin, and code Z79.4 is not required as an additional code.

Chapter 15 has a note at the beginning of the chapter to use an additional code to report the weeks of gestation.

The patient is 26 weeks’ gestation.

ICD-10-CM Alphabetic Index: Pregnancy < Weeks of gestation < 26 weeks < Z3A.26.

Verify code selection in the Tabular List.

According to ICD-10-CM guideline I.C.15.i, gestational diabetes is coded to subcategory O24.4-. Further in this guideline, it states that when gestational diabetes is controlled with both diet and insulin, only the insulin-controlled code is reported.

12. Rationale:

ICD-10-CM Alphabetic Index: Hemorrhage > After delivery > “see” Hemorrhage > postpartum > delayed or secondary > O72.2.

Verify code selection in the Tabular List.

The postpartum period is also known as the puerperal period

13. Rationale:

ICD-10-CM Alphabetic Index > Pregnancy > Complicated (by) > Abnormal, abnormality > Fetal heart rate or rhythm > O36.83-. The 6th character is 2 because the patient is in her second trimester at 25 weeks. 7th character 0 is reported for a single gestation.

Refer to the beginning of chapter 15 in the Tabular List that indicates what the certain number of weeks are for the trimesters.

Pregnancy after age 35 is considered an elderly pregnancy.

ICD-10-CM Alphabetic Index: Pregnancy > Complicated by > Elderly > Multigravida (because this is her second pregnancy) > O09.52-. In the Tabular List the 6th character 2 is reported to indicate the patient is in her second trimester.

There is also a note at the beginning of chapter 15 indicating to use an additional code from category Z3A to identify the specific week of the pregnancy.

ICD-10-CM Alphabetic Index: Pregnancy > Weeks of gestation > 25 weeks > Z3A.25.

Codes Z33.1 and Z34.82 are only reported when there are no complications documented.

Code P29.12 is only for use after the baby is born and not on the mother’s record.

Verify code selection in the Tabular List.

14. Rationale:

The labor is precipitous.

ICD-10-CM Alphabetic Index, look for Delivery (childbirth) (labor) > complicated/by > Precipitate labor > O62.3.

ICD-10-CM guideline I.C.15.n.1 states that code O80 is reported for a full-term normal delivery of a single, healthy infant without any complications antepartum, during the delivery, or postpartum during the delivery episode.

Code O80 is not to be reported with any other pregnancy complication code from chapter 15. 

In this case, O62.3 is reported for the complication and the normal delivery code (O80) is not reported.

The outcome of delivery is also reported.

ICD-10-CM Alphabetic Index: Outcome of delivery > Single > Liveborn > Z37.0.

Code Z38.00 is only to be used on the newborn’s record, not the maternal record.

At the beginning of chapter 15, there is a note to use an additional code to report the weeks of gestation.

The patient is 39 weeks’ gestation.

ICD10-CM Alphabetic Index: Pregnancy > Weeks of gestation > 39 weeks > Z3A.39.

Verify the code selection in the Tabular List.

Question 15 Rationale: Rationale: In the ICD-10-CM Alphabetic Index look for Hemorrhage, hemorrhagic/antepartum (with), guiding you to code O46.90. Turn to the Tabular List. The 5^th character 0 is for an unspecified antepartum hemorrhage, unspecified trimester. Notes at the beginning of chapter 15 indicate that 21 weeks lies in the 2^nd trimester. Further review of the codes in this category show that 5^th character 2 indicates second trimester, resulting in code O46.92. Code Z33.1 is only reported when the provider documents the medical condition is not related to the pregnancy. The spontaneous abortion code O03.9 is not reported because it is documented as a rule out. Z34.92 is for supervision of a normal pregnancy, which is not the case in this scenario with vaginal bleeding. At the beginning of chapter 15, under the notes, there is a reference to use an additional code from category Z3A, Weeks of gestation, to identify the specific week of the pregnancy. Look in the Alphabetic Index for Pregnancy/weeks of gestation/21 weeks, guiding you to code Z3A.21. Verify code selection in the Tabular List.