Gear Up for 2019 ICD-10-CM Code Changes – Part 3

Posted on 24 Sep, 2018 |comments_icon 0|By Elizabeth Debeasi

We’re back with Part 3 in our series on ICD-10-CM code changes, which are fast approaching implementation date. If you missed our earlier posts, be sure to read Part 1 and Part 2 to get the jumpstart you need to keep your claims on track come October 1st.

Now to move on with the lowdown on Dx code changes for ob-gyn and pediatrics!

Code Updates: Ob-gyn

Of the 450+ 2019 ICD-10-CM code changes, 33 apply directly to ob-gyn — from lumps in the breast and multiple gestation pregnancies to uterine disorders and obstetric surgical wound infections.

Staying on top of the new and revised ICD-10 codes should be a priority for your ob-gyn practice. Keep reading for an overview of the most relevant changes you’ll need to put under your belt to secure your deserved pay.

New Codes for Multiple Gestation 030

If you code for multiple-gestation pregnancies, you’ll choose from over a dozen new codes that specify that the number of chorions and amnions equal the number of fetuses. These include:


O30.1 Triplet pregnancy
  • O30.13 Triplet pregnancy, trichorionic/triamniotic
  • O30.131 – Triplet pregnancy, trichorionic/triamniotic, first trimester
  • O30.132Triplet pregnancy, trichorionic/triamniotic, second trimester
  • O30.133Triplet pregnancy, trichorionic/triamniotic, third trimester
  • O30.139 – Triplet pregnancy, trichorionic/triamniotic, unspecified trimester
O30.2 Quadruplet pregnancy
  • O30.23 – Quadruplet pregnancy, quadrachorionic/quadra-amniotic
  • O30.231 – Quadruplet pregnancy, quadrachorionic/quadra-amniotic, first trimester
  • O30.232Quadruplet pregnancy, quadrachorionic/quadra-amniotic, second trimester
  • O30.233 – Quadruplet pregnancy, quadrachorionic/quadra-amniotic, third trimester
  • O30.239 – Quadruplet pregnancy, quadrachorionic/quadra-amniotic, unspecified trimester
O30.8 Other specified multiple gestation
  • O30.83 Other specified multiple gestation, number of chorions and amnions are both equal to the number of fetuses

Pentachorionic, penta-amniotic pregnancy (quintuplets)
Hexachorionic, hexa-amniotic pregnancy (sextuplets)
Heptachorionic, hepta-amniotic pregnancy (septuplets)

  • O30.831 – Other specified multiple gestation, number of chorions and amnions are both equal to the number of fetuses, first trimester
  • O30.832 – Other specified multiple gestation, number of chorions and amnions are both equal to the number of fetuses, second trimester
  • O30.833Other specified multiple gestation, number of chorions and amnions are both equal to the number of fetuses, third trimester
  • O30.839 – Other specified multiple gestation, number of chorions and amnions are both equal to the number of fetuses, unspecified trimester
Update Your Zika Coding

Zika diagnosis codes were added in a couple of different places in the 2019 ICD-10-CM code set:

  • P35.4 Congenital Zika virus disease
  • Z20.821Contact with and (suspected) exposure to Zika virus
New Surgical Wound Infection Codes

You’ll also add more detail to your coding for obstetric surgical wound infections with new codes for:

O86.0 Infection of obstetric surgical wound
  • Excludes1: complications of procedures, not elsewhere classified (T81.4-)

postprocedural fever NOS (R50.82)
postprocedural retroperitoneal abscess (K68.11)

  • O86.00 – Infection of obstetric surgical wound, unspecified
  • O86.01 – Infection of obstetric surgical wound, superficial incisional site

Subcutaneous abscess following an obstetrical procedure
Stitch abscess following an obstetrical procedure

  • O86.02Infection of obstetric surgical wound, deep incisional site

Intramuscular abscess following an obstetrical procedure
Sub-fascial abscess following a procedure

  • O86.03 – Infection of obstetric surgical wound, organ and space site

Intraabdominal abscess following an obstetrical procedure
Subphrenic abscess following an obstetrical procedure

  • O86.04  Sepsis following an obstetrical procedure

Use Additional code to identify the sepsis

  • O86.09Infection of obstetric surgical wound, other surgical site

Remember: In 2019, you’ll need an additional character for O86.0- that provides more detail about the wound site. If you forget to add the additional character, the payer won’t accept the code.
New Postpartum Depression Codes

New codes are coming to distinguish postpartum depression from puerperal psychosis. The existing code F53 (Mental and behavioral disorders associated with the puerperium, not elsewhere classified) is out — replaced with codes F53.0 for postpartum depression and F53.1 for puerperal psychosis.

  • F53.0Postpartum depression
    • Postnatal depression, NOS
    • Postpartum depression, NOS
  • F53.1Puerperal psychosis
    • Postpartum psychosis
    • Puerperal psychosis, NOS
  • Z91.42Personal history of forced labor or sexual exploitation
New Z Code Options

Your ob-gyn practice also needs to make note of new Z codes for exams and screenings:

  • Z13.32 – Encounter for screening for maternal depression
  • Z62.813 – Personal history of forced labor or sexual exploitation in childhood
  • Z91.42Personal history of forced labor or sexual exploitation

Still, additional changes are on the horizon, including revisions to breast lump, ovarian pregnancy, fallopian tube removal codes, and more.

Code Updates: Pediatrics

Pediatric coders will find many code revisions and additions found in Chapter 16, Certain conditions originating in the perinatal period (P00-P96).

Newborn affected by amnionitis, newborn affected by membranitis, and newborn affected by placentitis have been deleted from P02.7. These items will now be indicated by a fourth character, specifically P02.78:

  • P02.70 Newborn affected by fetal inflammatory response syndrome

Newborn affected by FIRS

  • P02.78 Newborn affected by other conditions from chorioamnionitis

Newborn affected by amnionitis

Newborn affected by membranitis

Newborn affected by placentitis

A similar change has been made to P04.1, which no longer includes newborn affected by cancer chemotherapy and newborn affected by cytotoxic drugs. A note has been added to this code, instructing coders to “code first withdrawal symptoms from maternal use of drugs of addiction, if applicable (P96.1)”.

Also, Excludes1: maternal use of drugs of addiction (P04.4-) has been deleted.

New codes added to the P04.1 category include:

  • P04.11 – Newborn affected by maternal antineoplastic chemotherapy
  • P04.12Newborn affected by maternal cytotoxic drugs
  • P04.13Newborn affected by maternal use of anticonvulsants
  • P04.14Newborn affected by maternal use of opiates
  • P04.15Newborn affected by maternal use of antidepressants
  • P04.16Newborn affected by maternal use of amphetamines
  • P04.17Newborn affected by maternal use of sedative-hypnotics
  • P04.1ANewborn affected by maternal use of anxiolytics
  • P04.18Newborn affected by other maternal medication
  • P04.19Newborn affected by maternal use of unspecified medication

New codes have also been added to P04.4 (Newborn affected by maternal use of drugs of addiction) and P04.8 (Newborn affected by other maternal noxious substances).

  • P04.40Newborn affected by maternal use of unspecified drugs of addiction
  • P04.42Newborn affected by maternal use of hallucinogens
  • P04.81Newborn affected by maternal use of cannabis
  • P04.89Newborn affected by other maternal noxious substances

New Infections Specific to the Perinatal Period 

P35 Congenital viral diseases

A new code has been added for congenital Zika virus disease, P35.4. Coders are instructed to use an additional code to identify manifestations of congenital Zika virus disease.

Transitory Electrolyte Disturbances in the Neonatal Period

P74 has undergone a major overall in 2019, with several new options to depict transitory endocrine and metabolic disorders specific to newborns. These code additions include:

  • P74.21Hypernatremia of newborn
  • P74.22Hyponatremia of newborn
  • P74.31Hyperkalemia of newborn
  • P74.32 – Hypokalemia of newborn
  • P74.41 – Alkalosis of newborn
  • P74.42Disturbances of chlorine balance of newborn
  • P74.421 — Hyperchloremia of newborn
  • P74.422 — Hypochloremia of newborn
  • P74.49Other transitory electrolyte disturbance of newborn

Development Disorders Get Much Needed Specificity

Up until the now, diagnoses like autism were lumped in with all other development disorders in an undifferentiated Z13.4 — which should drive home the need for more code options to precisely name specific conditions.

To address this need, the 2019 ICD-10-CM code set is expanding on Z13.4- (Encounter for screening for certain developmental disorders in childhood) to offer four more screening codes for childhood developmental disorders, including:

  • Z13.40Encounter for screening for unspecified developmental delays
  • Z13.41Encounter for autism screening
  • Z13.42Encounter for screening for global developmental delays (milestones)
  • Z13.49Encounter for screening for other developmental delays.

Coders should note the Excludes1 instruction for Z13.4- that prohibits reporting with Z00.1- (Encounter for newborn, infant and child health examinations) has been deleted and replaced with an Excludes2 note, clarifying that Z13.4- codes are separately reported from the codes with Z00.12- (Encounter for routine child health examination).

Additionally, a new Z code has been added to the Z62 category “Problems Related to Upbringing” that identifies patients with potential health hazards related to socioeconomic and psychosocial circumstances. Based on documentation, it is acceptable for nonphysician clinicians to report this new code, Z62.813 (Personal history of forced labor or sexual exploitation in childhood).

Learn More

Join us later this week for Part 4 in this series, where we’ll unpack the 100+ code changes for ophthalmology! And if you missed our earlier posts, be sure to check out Part 1, which unravels key code changes for cardiology and emergency medicine. In Part 2, we lay out new diagnostic codes primarily impacting gastroenterology, general surgery, internal medicine, and primary care.

Don’t risk your bottom line on last year’s codes. Rely on the industry’s top ICD-10-CM coding resources!

The ICD-10-CM for Physicians & Hospitals 2019 is loaded with exclusive bonus chapters and the best-in-class features you need for accurate coding and optimal reimbursement. With this best-selling ICD-10-CM coding book in hand, you’ll achieve your most profitable year—free of stress and strife!

How would you like expert, to-the-point ICD-10 coding guidance delivered to you each month? Defeat the revenue-risking issues that threaten your claims success with practical ICD-10 training strategies, answers to your ICD-10 coding questions, and specific examples to help you apply ICD-10 coding fundamentals. Simply subscribe to TCI’s ICD-10 Coding Alert.


Elizabeth Debeasi
Marketing Writer/ Editor

Elizabeth works on an array of projects at TCI, researching and writing about modern reimbursement challenges. Since joining TCI in 2017, she has also covered the nuts and bolts of cybersecurity, compliance with federal laws, and how to tap into the advantages of Telehealth services.

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