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Failed attempted abortion O07
includes failure of attempted induction of TOP either legal or illegal, will only be used when a fetus is still present. Fourth character subdivisions are provided with this category to identify maternal complications
Threatened miscarriage is bleeding in pregnancy prior to 24 completed weeks and is classified at O20.0 within the haemorrhage in eRly pregnancy category.
Unspecified Abortion O06
Indicates that the type of TOP is NOT known.
O06 must not be used for inpatient TOP coding as it would be expected that the patient medical record would contain complete document ion regarding patients condition. If type ofTOP is not documented the coder must obtain this information from responsible consultant.
Only circumstances in which this category is valid for use is in cases where a direst inadvertant loss of pregnancy takes place
Spontaneous Abortion O03
Referred to as spontaneous miscarriage and is the explusion or extraction of the baby or fetus before the 24th completed weeks without deliberate interference and is a natural end to the pregnancy.
Category O03 requires the addition of a fourth character subdivision ( found in tabular list) to identify whether the miscarriage was complete or incomete and if there were any maternal complications.
Termination of pregnancy resulting in liveborn
- Where a patient undergoesTOP resulting in a live fetus where the baby has lived for any amount of time, regardless of festoon all age, this must be coded as an abortion using a code from O04-O06.
- A code from Z37.- outcome of delivery must also be assigned to indicate that the termination of pregnancy resulted in Livebirth.
Is the complete expulsion or extraction from its mother of a fetus or baby, which after separation, breathes or shows other evidence of life. This is irrespective of duration of pregnancy
Is the estimated age of the fetus usually calculated by means of an ultrasound scan.
gestational age is expressed in completed weeks.
Retained Products of Conception. RPOC
Are the retention of any part of the plan at tissue, membranes, gestational sac or fetal pole following miscarriage or termination of pregnancy
Miscarriage is defined as the spontaneous loss of pregnancy before 24 completed weeks of gestation and is the expulsion or extraction of all or any part of a non-continuing pregnancy, including placenta tissue, Membranes, gestation sac or fetus before the 24 th completed week of pregnancy.
miscarriage includes all pregnancy losses. From the time of conception until 24 weeks of gestation.
the term miscarriage is used here to spontaneous or missed abortion as this is the recommended term for use in clinic practice for the spontaneous loss of pregnancy before 24 weeks. After the 24 th completed week the loss of. Pregnancy is defined as still birth or late intrauterine fetal death
Ectopic pregnancies are those that develop in a site other than the uterus, the most common site being the Falliopion tube.
the fourth character subdivision identifies the site of the ectopic pregnancy.
Hydatidiform mole may also be referred to as gestational trophoblastic disease. Hydatidiform moles can be diagnosed on ultrasound but can be confirmed by histological examination of the products of conception. Hydatidiform moles are notifiable to cancer registry as if left, they have the potential of becoming malignant
Other abnormal products of conception (O02)
O02.- missed abortion - known as missed miscarriage or early fetal demise, early uterine death, silent miscarriage or delayed miscarriage.
it is the retention of a dead fetus before 24 cometed weeks of gestation. This diagnosis is made before any bleeding has taken place eg at a routine scan.
O02 must only be used when there has been no bleeding and no products of conception have been passed.
THe patient may have no symptoms of miscarriage but will eventually start to bleed and physically miscarry the fetus.
When end bleeding is noted or products of conception are pSsed this must be coded to O03.- Spontaneous Abortion.
Spontaneous abortion O03.-
referred to as spontneons miscarriage and is the expulsion or extraction of the baby or dero before the 24 completed weeks without deliberate interference and is a natural end to the pregnancy.
Category O03.- requires the addition of a fourth character ( found in Tabular list) to identify whether the miscarriage was complete or incomplete and if there were any maternal complications.
- Spontaneous us miscarriage can be subdivided into:
Misscarriage has started, bleeding is present but not all of the fetal tissue has been passed ie RPOC.
The assignment of a fourth character .0-.4 indicates that the misscarriage was incomplete and also if there were any maternal complications.
The pregnancy has been lost, uterus is empty and there are no RPC.
The assignment of fourth character .5-.9 indicate that the miscarriage was complete and also if there were any maternal complications.
if spontaneous delivery of a non-viable fetus occurs prior to 24 completed weeks gestation the episode must be classified as a spontaneous abortion.
Medical Abortion O06.-
Is the interruption of pregnancy for legally acceptable medically approved indications.
This is category includes both elective termination of pregnancy TOP at the patients request and therapeutic TOP performed for suspected fetal abnormalities.
Terminations can be performed using surgical methods such as vacuum aspiration or by means using abortifacients drugs.
Termination of pregnancy O04.- - O 07.-
Abortion is the termination of a continuing pregnancy by medical or surgical means. It is the expulsion or extraction of all or any part of the pregnancy, including the placenta tissue, membranes, gestation sac and fetus.
- the term Termination of Pregnancy is the preferred term used by clinical staff when referring to Abortion within codes O94 - O 07
- Most terminations take place before the 24 completed weeks of oregnancy, however some may take place beyond 24 completed weeks. Termination of pregnancy must be coded using a code from O04. - O 07 irrespective of gestational age or if the baby is stillborn or liveborn.
categories O04-O97 require fourth character to identify whether the termination of pregnancy was complete or incomplete and if there were any maternal complications.
Other abortion O05
Illegally induced abortion (TOP) the illegal interruption of oregnancy by any means
a coder would not be expected to use this category
Unspecified Abortion O06
This category indicates that the type of termination is not known.
Most not be used for inpatient TOP as it would be expected that pt medical records would contain complete documentation regarding patients condition.
If type of TOP is not documented coder must obtain this information from responsible consultant.
The only circumstance in which this cate gory is valid for use is in cases where a direct inadvertent loss of pregnancy takes place.
Failed attempted abortion O07
includes failure of attempted induction of TOP either legal or illegal.
will only be used when the fetus is still present.
fourth character subdivisions are provided with this category to identify maternal complications
Termination of pregnancy resulting in liveborn
Where a patient undergoes TOP resulting in a live fetus where the baby has lived for any amount of time, regardless of gestational age this must be coded as an abortion using a code from O04-O06.
A code from Z 37 Outcome of delivery must also be assigned in the first secondary diagnosis field to indicate that the TOP resulted in a live birth
Inadvertent loss of pregnancy
- inadvertent or intentional loss of pregnancy may result from two possible different causes.
- 1) inadvertent loss of pregnancy due to direct cause
direct cause of inadvertent loss of pregnancy is when the patient undergoes uterine surgery eg hysterectomy, for a known or suspected condition and the pregnancy is unavoidably terminated due to the nature of the procedure.
Category O06 Unspecified abortion is used to classify an inadvertent loss of pregnancy due to direct cause because the pregnancy has been terminated due to uterine surgery
the main condition treated during the relevant consultant episode is reported as the primary diagnosis followed by O06 with the appropriate fourthcharacter.
2) inadvertent loss of pregnancy due to indirect cause
a. Indirect cause of inadvertent loss of pregnancy not on the uterus, for a life threatening (or other) condition the treatment of which cannot be postponed and the patient experiences a spontaneous miscarriage as a result of this treatment.
category O03 Spontaneous abortion is used to classify the inadvertent loss of pregnancy due to indirect cause.
- The main condition treated during the consultant episode is recorded as the primary diagnosis followed by he appropriate code from O03 to indicate spontaneous miscarriage.
Medical termination of pregnancy
patients admitted for administration of abortifacients drugs eg (mifepristone) or pressaries for TOP are usually kept in hospital until they have aborted the pregnancy, however sometimes they may be discharged to abort the pregnancy at home.
if pt kept on hospital & they abort the pregnancy whilst in hospital then code as a complete medical abortion with the appropriate fourth character from .5-.9
if pt discharged to abort the pregnancy at home they must also be coded to O04 Medical abortion with appropriate fourth character from .5-.9 to indicate an unspecified medical TOPiw( not specified as incomplete or complete). This is because the termination process has started by the administration of the abortifacients. This guidance would apply where the patient begins to bleed before discharge home to abort the pregnancy, as this is a sign the process of aborting the pregnancy has begun.
If the pt is admitted solely for the purpose of receiving abortifacicent drugs for TOP code Z51.2 Other chemotherapy is assigned as an additional code whether pt snorts in hospital or home
Cancellation of medical termination ofpregnancy
If patient changes their mind about a medical TOP a code from Z34 Supervision of normal pregnancy followed by Z53.2 Procedure not carried out because of patients decision for other and unspecified reasons is assigned, providing there are no other complications present classifiable to Chapter XV or Z35 Supervision of high rusk pregnancy.
if patient admitted for TOP due to current condition classifiable to chapter XV but changes their mind appropriate code from O10-O45 or categories O95-O99 must be assigned to identify the pregnancy related condition followed by Z53.2
if pt has been admitted for a TOP due to history of a pregnancy related condition that is classifiable to categories O10-O92 & changes their mind code Z35.2 supervision of pregnancy with poor reproductive or obstetric history & Z53.2 must both be assigned.
if a pt hS been admitted for TOP because it is considered to be high risk eg pt is an elderly primo gravies ) and changes their mind code Z35 & Z53.2 must both be assigned.
Complication following abortion and ectopic and molar pregnancy O08
closes in this category are not to be used in a primary position except where there is a new consultant episode or hospital provider spell which is solely for treatment of the complication eg a current complication of a previous abortion or miscarriage.
Codes in O08 must be used as additional codes with O00-O02 to identify associated complications & may be used with categories O03-I07 to give further information.
Complications following ectopic pregnancy.Molar pregnancy, miscarriage and termination of pregnancy
There are 3 types of complications associated with ectopic pregnancy, molar pregnancy, miscarriage and termination of pregnancy .
1) maternal complication of ectopic pregnancy, molar pregnancy, miscarriage and TOP (abortion)
The first type of complication refers to maternal complications; conditions affecting the mother which causes, results from, or otherwise associated with the ectopic pregnancy, molar pregnancy, miscarriage or termination of pregnancy.
A table of complications is shown in the alpha index under the lead term Abortion complicated by. This table identifies the fourth character subdivisions to be used for miscarriages and terminations of pregnancy as follows:
- first column identifies the fourth character to be used with category Oo3 when complete or unspecified
second column identifies the fourth character to be used with category O03 when complete.
- Termination of Pregnancy
- first column identifies the fourth character to be used with categories O04-O06 when complete or unspecified
second column identifies the fourth character to be used with categories O04-O06 when complete.
- the third column identifies the fourth character to be used with category O08
- code assignment for maternal complications is dependent upon when the complication occurred. Maternal complications of miscarriage and TOP themselves can be classified in 3 different ways.
- a) manual complications occurring during the same consultant episode as the ectopic pregnancy molar pregnancy, misscarriage or termination of pregnancy itself are classified using codes in categories Ooo-O07. Categories O03-O06 all require the assignment of a fourth character to identify the type of complication eg haemorrhage.
a code from O08 Complications following abortion and ectopic and molar pregnancy must be used in addition to the codes from the range O00-O02 to identify any associated conditions & can be used with O03-O07 to give further information about the complication.
- B) Second type of maternal complication refers to maternal complications occurring on a subsequent consultant episode were the patient has retained products of conception following a previous medical TOP or spontaneous miscarriage. These are recorded as follows:
- Medical termination of pregnancy episode
- must be coded as a complete medical termination of pregnancy on completion of the procedure
- . Code assignment would be from category P04 Medical abortion with fourth character from .5-.9
- retained products of conception episode ( following previous medical termination of pregnancy)
- This must be coded as an incomplete medical termination of pregnancy By assigning O04 with relevant fourth character .0-.4
- Retained Products of Conception after previous spontaneous miscarriage
- Spontaneous miscarriage episode
- . Must be coded as a spontaneous miscarriage using O03 Spontaneous abortion with fourth character from .0-.9
Retained products of conception episode ( following spontaneous miscarriage)
- . Must be coded as an incomplete spontaneous miscarriage assigning code from O03, with relevant fourth character from .0 to .4 to indicate an incomplete misscarriage.
- Even if a procedure for the retained products of conception eg ERPC was carried out on the spontaneous miscarriage episode the retained products episode would still be coded to an incomplete spontaneous miscarriage as it's considered to be ongoing treatment of a spontaneous miscarriage.
- C) third type of maternal complications are those occurring in a subsequent consultant episode to that in which the ectopic pregnancy, molar pregnancy, miscarriage or TOP occurred and where there are NO retained products of conception.. These r classified using code O08 complications following abortion and ectopic and molar pregnancy.
- A code fromO08 must Not be used as a primary diagnosis except where the new consultant episode is solely for treatment of a complication of a previous miscarriage or TOP
2)Fetal complications as the reason for termination of pregnancy (abortion)
- the second type of complication refers to the fetal complications as the reason for early termination of pregnancy. Assigned as follows:
- . Assign a code for the TOP itself (O04-O07) as the primary diagnosis
- . Assign a code for the fetal complication.1
- The fetal complication may also be the result of a condition which has been experienced by the mother that is no longer present.
3) Fetal complications and maternal complications occurring in the same consultant episode
The third type refers to fetal complications as the reason for TOP and maternal complications of the termination occurring during the same consultant episode.
- When a fetal complication is the reason for termination of pregnancy and maternal complications also occur, codes for both types of complications must be assigned as follows:
- . Assign a code for the termination of pregnancy itself O04-O07 as the primary diagnosis
. Assign a code for the fetal complication
. Assign a code from category O08 to give further infostion about the maternal comucation if it is not stated at the fourth character level in the termination code O 04-O07
Oedema, protein urial and hypertensive disorders in pregnancy, childbirth & the puerperium O10-O16
Eclampsia ( convulsion & coma in pregnancy or puerperium associated with hypertension, oedema & proteinuria), pre-eclampsia (HTN, oedema, & proteinuria in pregnancy ) oedema, protein urial and hypertensive disorders are coded to this block for all stages of pregnancy, childbirth & puerperium.
- Hypertension may be pre-existing condition which is complicated by Preg, childbirth & puerperium , or it mat be gestational
Haemorrhage in early pregnancy O20
Includes bleeding before 24 weeks completed weeks gestation In the UK but excludes pregnancy with abortive outcome which is coded to O00-O08
Codd O 20.0 - classifies a diagnosis of threatened miscarriage bleeding in pregnancy prior to 24 completed weeks.
If threatened miscarriage proceeds to miscarriage then this must be coded to O03Spontaneous Abortion
Excessive vomiting in pregnancy O21
Hyperemesis gravidarum or excessive vomiting in pregnancy is only coded when clinically significant. For thus to be assigned the patient must have been admitted because of, or treated solely for the vomiting. Fourth character subdivision identifies number of weeks gestation.
Infections of genitourinary tract in pregnancy O23
Urinary infections of named anatomical sites other than kidney, bladder and urethra must be coded to O23.3
infections of the genital tract (reproductive organs) such as scalping I-oomph orris must be coded to B95-B98 to identify the organism causing the infection when known.
Diabetes myelitis in Pregnancy O24
fourth character subdivisions are available to identify either pre-existing diabetes by type, or gestational diabetes.
if the diabetes is causing certain manifestations which would normally be classified using the dagger and asterisk system, a code from O24 will become the dagger code.
Maternal care for other conditions predominantly related to pregnancy O26
This category used for conditions solely pregnancy induced.
Pre-existing conditions that affect the pregnancy should be coded to O 99 Other maternal diseases classifiable elsewhere but complicating pregnancy, childbirth and the puerperium
pregnancy care of habitual snorter O 26.2 is recorded here and consequently excluded from category Z35
Liver disorders in pregnancy chmdbirth & puerperium O26.6
Includes obstetric chole stasis also referred to as cholestasis of pregnancy or intraheoatic cholestasis of oregnancy.
it is not necessary to assign a code from Chapter XI in addition