COVID-19: pregnancy and newborn coding

We have been flooded with news stories about COVID-19 wreaking havoc on the health and well-being of different segments of the population: the elderly, patients with underlying chronic condition and children to name a few. In this blog post, I will focus on pregnant patients and their newborn infants in terms of coding COVID-19-related situations they may experience.

The Centers for Disease Control and Prevention’s (CDC) website provides information to persons who are pregnant and those caring for infants during the current public health emergency. The CDC notes that it believes pregnant women have the same risk of contracting COVID-19 as those who are not pregnant, but it is known that  “pregnant people have had a higher risk of severe illness when infected with viruses that are similar to COVID-19 as well as other viral respiratory infections, such as influenza.”

The CDC also posted that a very small number of newborns have tested positive for COVID-19, but it is unknown if the infants were infected before or after birth. The CDC confirmed that the virus has not been detected in samples of amniotic fluid, breast milk or other maternal samples at this time.

Based on this information and the fact that mothers and newborns have tested positive for COVID-19, it's important to review coding guidelines for these patients.

First, let's review several ICD-10-CM coding guidelines for conditions in pregnancy that must still be applied when coding pregnancy encounters in the COVID-19 positive patient:

• ICD-10-CM codes from Chapter 15, Pregnancy, Childbirth and the Puerperium have sequencing priority over codes from other chapters. Additional codes from other chapters may be used in conjunction with Chapter 15 codes to further specify conditions as needed.
• Should the provider document that the pregnancy is incidental to the reason for the encounter, code Z33.1, Pregnant state, incidental, should be used in place of any chapter 15 codes. It is the provider’s responsibility to state that the condition being treated is not affecting the pregnancy.
• Codes from Chapter 15 should only be used on the maternal record, never on the newborn record.

Newborn Guidelines

• For coding and reporting purposes, the perinatal period is defined as before birth through the 28th day following birth.
• If a newborn has a condition that may be due to the birth process or is community acquired, and the documentation does not indicate which it is, the default selection is due to the birth process and ICD-10-CM codes from Chapter 16, Certain Conditions Originating in the Perinatal Period should be used. If the condition is documented as community-acquired, a code from Chapter 16 should not be assigned.

Next, let’s look at some COVID-related scenarios and associated code assignment: 

1. Pregnant mother with confirmed COVID-19

Code O98.51_, Other viral diseases complicating pregnancy should be sequenced first followed by code U07.1, COVID-19.

Per the coding guidelines, codes from Chapter 15 must be first-listed.

2. Mother delivered infant during previous encounter; mother now COVID-19 positive confirmed 3 weeks post-partum

Code O98.53, Other viral diseases complicating the puerperium and U07.1, COVID-19.

The postpartum period, clinically termed the "puerperium," begins immediately after delivery and includes the subsequent six weeks. A postpartum complication is defined as any complication that occurs during that six-week period.

3. Pregnant mother presents with cough, fever and shortness of breath with confirmed exposure to COVID-19; mother tested negative and COVID-19 ruled out

Code O99.89,  Other specified diseases and conditions complicating pregnancy, childbirth and the puerperium, R05, Cough, R50.9, Fever, R06.02, Shortness of breath and Z20.838, Contact with and (suspected) exposure to other viral communicable diseases.

4. Pregnant mother, primigravida, 2^nd trimester, asymptomatic, possible exposure to COVID-19, ruled out

Code Z34.02, Encounter for supervision of normal first pregnancy, second trimester and Z03.79, Encounter for other suspected maternal and fetal conditions ruled out.

This category is to be used when a person without a diagnosis is suspected of having an abnormal condition without signs or symptoms that requires study, but after examination and observation is ruled out. 

5. Pregnant mother without symptoms, no contact/exposure or no suspected exposure, negative or unknown test result

Code Z34.__, Encounter for supervision of normal pregnancy and Z11.59, Encounter for screening for other viral diseases

Screening is the testing for disease or disease precursors in asymptomatic individuals so that early detection and treatment can be provided for those who test positive for the disease.

Newborns:

6. Infant delivered on this admission, mother tested positive for COVID-19, newborn tested positive, confirmed infection was due to the birth process

Code Z38._, Liveborn infants according to place of birth and type of delivery, P35.8, and U07.1, COVID-19

Per ICD-10-CM coding conventions, Code Z38._ is sequenced as the principal diagnosis on the initial record of a newborn baby.

Codes from category P35 are for use when infections are acquired in utero, during birth via the umbilicus, or during the first 28 days after birth.

***It is possible a baby may be admitted before the 28th day of life due to COVID-19; if documentation is unclear, the provider may need to be queried to determine if the COVID-19 diagnosis is due to the birth process or community acquired. 

7. Newborn, mother tested positive for COVID-19 or newborn with possible exposure within the neonatal period, asymptomatic, ruled out, delivered on this admission

Code Z38.__, Liveborn infants according to place of birth and type of delivery and Z05.1, Observation and evaluation of newborn for suspected infections condition ruled out.

This category should be used for newborns within the neonatal period (the first 28 days of life), who are suspected of having an abnormal condition, but without signs or symptoms and which, after examination and observation, is ruled out.

Bobbie Starkey, RHIT, CCS-P, is an outpatient consultant with Solventum.

During a pandemic, healthcare information is gathered, studied, and published rapidly by scientists, epidemiologists and public health experts without the usual processes of review. Our understanding is rapidly evolving and what we understand today will change over time. Definitive studies will be published long after the fact. 3M Inside Angle bloggers share our thoughts and expertise based on currently available information.