In diagnosis coding, we have specific coding guidelines for each chapter. In ICD 10 codes, we have very specific codes and this specificity can be calculated from diagnosis codes for pregnancy chapter. In pregnancy complication codes, we have now specific ICD 10 codes for each trimester and weeks of gestation (Z3A category).

Be careful with use of Z3A category codes for weeks of gestation. Z3A category codes should not be used with abortion codes as per the coding guidelines. The most common issues with ICD 10 codes is the selection of primary diagnosis. The same confusion happens in coding pregnancy ICD 10 codes. There are a list of encounter codes which should be assigned as primary diagnosis only.

Read also: Best coding tips for Abortion CPT codes

Coding for Routine Outpatient Prenatal visits

During pregnancy, normal outpatient visits are done to avoid any complications in future. If there is normal pregnancy, there are separate list of ICD 10 codes for supervision for these visits. Also, we have check for primigravida and multigravida. 

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

Multigravida – a woman that is or has been pregnant for at least a second time.

Now, for a first time pregnant women we have to report below ICD 10 codes for routine oupatient prenatal visits.

Z34.00 Encounter for supervision of normal first pregnancy, unspecified trimester

Z34.01 Encounter for supervision of normal first pregnancy, first trimester

Z34.02 Encounter for supervision of normal first pregnancy, second trimester

Z34.03 Encounter for supervision of normal first pregnancy, third trimester

And, for a women, who is pregnant for at least a second time, should be reported with below ICD 10 codes for routine or normal outpatient prenatal visits.

Z34.80 Encounter for supervision of other normal pregnancy, unspecified trimester

Z34.81 Encounter for supervision of other normal pregnancy, first trimester

Z34.82 Encounter for supervision of other normal pregnancy, second trimester

Z34.83 Encounter for supervision of other normal pregnancy, third trimester

All these encounter codes should be reported as first listed or principle diagnosis. These codes should never be used along with pregnancy complication ICD 10 codes or chapter 15 codes. 

“Normal and Complication codes of Pregnancy chapter should never be coded together” 

Read also: ICD 10 coding guidelines for Diabetes and its complication

When to use Supervision of High-Risk Pregnancy ICD 10 code

For high risk pregnancy, we have to report a code from category O09 for routine prenatal visits. Assign a code from chapter 15 for complications during the labor or delivery episode in high risk pregnancy. When there are no complications during the labor or delivery episode, use below ICD 10 code for uncomplicated delivery.

O80 Encounter for full-term uncomplicated delivery

Codes 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 no delivery episodes, the principal diagnosis should be reported based on the complication of the pregnancy which led the encounter. If there are more than one complication responsible for the encounter, any of the complications codes can be sequenced as first listed diagnosis.