2018 ICD-10 code updates for pregnancy: Pick a side

Sept. 15, 2017 / By Allison Morgan, MS, CPC

September has finally arrived and with it comes the start of fall.  For those of us in health care, it also signifies our own version of a New Year…for ICD-10 codes to be exact. This year’s 2018 ICD-10-CM update brings over 300 new additions to the ICD-10 code family. A major change with this year’s update impacts the pregnancy, childbirth and the puerperium conditions found in the “O” series of codes.

CMS has identified tubal pregnancies with and without intrauterine pregnancy, as well as ovarian pregnancies with and without intrauterine pregnancy for some much-needed updates.  Historically, lateral status was absent in the code description, but we now have an option of right, left and unspecified status when reporting these conditions associated with the mother’s tubes or ovaries. This now means it’s time to pick a side when it comes to assignment of these codes. A detailed breakdown of the deletions and additions is below:

Deletion of O00.10   Tubal pregnancy without intrauterine pregnancy

• Addition of O00.101 Right tubal pregnancy without intrauterine pregnancy
• Addition of O00.102 Left tubal pregnancy without intrauterine pregnancy
• Addition of O00.109 Unspecified tubal pregnancy without intrauterine pregnancy

Deletion of   O00.11   Tubal pregnancy with intrauterine pregnancy

• Addition of O00.111 Right tubal pregnancy with intrauterine pregnancy
• Addition of O00.112 Left tubal pregnancy with intrauterine pregnancy
• Addition of O00.119 Unspecified tubal pregnancy with intrauterine pregnancy

Deletion of O00.20   Ovarian pregnancy without intrauterine pregnancy

• Addition of O00.201 Right ovarian pregnancy without intrauterine pregnancy
• Addition of O00.202 Left ovarian pregnancy without intrauterine pregnancy
• Addition of O00.209 Unspecified ovarian pregnancy without intrauterine pregnancy

Deletion of O00.21   Ovarian pregnancy with intrauterine pregnancy

• Addition of O00.211 Right ovarian pregnancy with intrauterine pregnancy
• Addition of O00.212 Left ovarian pregnancy with intrauterine pregnancy
• Addition of O00.219 Unspecified ovarian pregnancy with intrauterine pregnancy

The welcomed addition of these codes not only allows for more accurate and specific reporting of these conditions, but it also reminds us of the importance of documenting key elements to support specificity regardless of the condition or chapter that we are coding from. In procedural documentation, this can include components such as:

• Laterality
• Anatomical location
• Age
• Trimester status
• Screening condition

The annual rollout of the ICD-10 update in October can be a convenient time to remind and educate providers as to the necessity of these definitive components in their documentation. For both the radiologist and the ordering physician, it is essential they provide the most definitive documentation possible to maintain patient accuracy in records maintenance and for denial management in the revenue cycle.

This documentation is also key to successful and accurate code suggestion by your computer-assisted coding system. Auto suggestion of codes is dependent on the quality of language and documentation provided and also reinforces compliant documentation practices. 3M approaches each year’s update with this focus, reviewing all existing coding rules and establishing new rules to reflect the 2017 ICD-10-CM and PCS updates and providing educational opportunities, including webinars about the impact on documentation. So, the next time you encounter documentation related to tubal or ovarian pregnancies, be sure to pick a side. 

Allison Morgan is a clinical development analyst at 3M Health Information Systems.