ICD-10 coding challenge: Coding of supervision of high-risk pregnancy on inpatient records

Jan. 30, 2017 / By Sue Belley, RHIA

Julia Palmer, project manager with the consulting services business of 3M Health Information Systems, is author of this month’s coding challenge blog.

A patient with history of a stillbirth was admitted to the hospital for delivery. The patient subsequently delivered a healthy baby boy at 7 pounds 8 ounces via normal spontaneous vaginal delivery without complications and was discharged home on the second hospital day.

Assign all applicable ICD-10 diagnosis and PCS codes for the previous inpatient hospital encounter.


O80        Encounter for full term uncomplicated delivery

Z370      Single live birth

10E0XZZ  Delivery of products of conception, external approach  


Everyone who participated in this month’s coding challenge did an excellent job. Many of you correctly noted we failed to include weeks of gestation which would be highly unlikely to NOT be documented. Some of you added Z3A00, weeks of gestation not specified, and there is certainly nothing wrong with doing that.

The point of this challenge was to note that code O09293, Supervision of pregnancy with other poor reproductive or obstetric history, third trimester (history of stillbirth), is not appropriate for this encounter but you already knew that because no one assigned this code! Good for you and give yourself a pat on the back. However, here at 3M we are still seeing coders assign codes from category O09 to inpatient encounters.

So for the record, here is the rule from the 2017 ICD-10-CM Official Guidelines for Coding and Reporting, effective October 1, 2016 (the bold face type indicates that this is a change from previous guidelines):

Supervision of 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.

Thank you for participating and hope to see you back here next time.

Julia Palmer is a project manager with the consulting services business of 3M Health Information Systems.