Coding guideline for Supervision for high risk pregnancy

Codes from category O09, Supervision of high-risk pregnancy, are intended for use only during the prenatal period.  For complications during the labor or delivery episode as a result of a high-risk pregnancy, assign the applicable complication codes from Chapter 15. If there are no complications during the labor or delivery episode, assign code O80, Encounter for full-term uncomplicated delivery.

For routine prenatal outpatient visits for patients with high-risk pregnancies, a code from category O09, Supervision of high-risk pregnancy, should be used as the first-listed diagnosis. Secondary chapter 15 codes may be used in conjunction with these codes if appropriate.

For routine outpatient prenatal visits when no complications are present, a code from category Z34, Encounter for supervision of normal pregnancy, should be used as the first-listed diagnosis. These codes should not be used in conjunction with chapter 15 codes. The excludes1 notes has clearly documented these codes.

 Z34 Encounter for supervision of normal pregnancy

Excludes1: any complication of pregnancy (O00-O9A)
encounter for pregnancy test (Z32.0-)
encounter for supervision of high risk pregnancy (O09.-)

Supervision of elderly primigravida and multigravida

Primigravida -a woman who is pregnant for the first time.

Pregnancy for a female 35 years and older at expected date of delivery

O09.51 Supervision of elderly primigravida
O09.511 Supervision of elderly primigravida, first trimester
O09.512 Supervision of elderly primigravida, second trimester
O09.513 Supervision of elderly primigravida, third trimester
O09.519 Supervision of elderly primigravida, unspecified trimester

O09.52 Supervision of elderly multigravida

O09.521 Supervision of elderly multigravida, first trimester
O09.522 Supervision of elderly multigravida, second trimester
O09.523 Supervision of elderly multigravida, third trimester
O09.529 Supervision of elderly multigravida, unspecified trimester

For pregnancy for a female less than 16 years old

O09.6 Supervision of young primigravida and multigravida
Supervision of pregnancy for a female less than 16 years old at expected date of delivery

O09.61 Supervision of young primigravida
O09.611 Supervision of young primigravida, first trimester
O09.612 Supervision of young primigravida, second trimester
O09.613 Supervision of young primigravida, third trimester
O09.619 Supervision of young primigravida, unspecified trimester

O09.62 Supervision of young multigravida
O09.621 Supervision of young multigravida, first trimester
O09.622 Supervision of young multigravida, second trimester
O09.623 Supervision of young multigravida, third trimester
O09.629 Supervision of young multigravida, unspecified trimester

Pregnancy Trimester anatomy and physiology

FIRST TRIMESTER
• 0-14 Weeks
– Morning Sickness
– Sensitive/Sore breasts with Breast Growth
– Frequent urination
– Constipation
– Fluctuating Emotions (hormonal based

SECOND TRIMESTER
• 14-28 Weeks
– Frequent Urination
– Insomnia, Indigestion, Muscle Cramping
– Pain associated with Uterine stretching & fetal growth
– Leukorrhea/Vaginal discharge

THIRD TRIMESTER
• 28-40+ WEEKS
– Pregnancy Blahs – Mild/moderate depression
– Breathlessness due to pressure on the diaphragm
– Edema – localized usually to the lower extremities
– Pre-eclampsia/eclampsia
• High blood pressure
• Protein in urine
• 4% restricted blood flow to placenta
• Eclampsia/seizures – 2nd leading cause of maternal death