Medical Policy Medical Policy
Policy Num: 04.001.001
Policy Name: Antepartum Fetal Evaluation
Policy ID: [04.001.001] [Ar / L / M+ / P] [0.00.00]
Last Review: June 16, 2022
Next Review: Policy Archived
Issue: 6:2022
ARCHIVED
Related Policies: None
| Population Reference No. | Populations | Interventions | Comparators | Outcomes |
| 1 | Individuals: | Interventions of interest are: · Antepartum evaluation | Comparators of interest are: · No fetal evaluation | Relevant outcomes include: · Perinatal morbisity · Perinatal mortality |
In humans as well as in animals, the fetal heart rate pattern, activity level, and degree of fetal muscle tone are sensitive to hypoxemia and acidemia. Various techniques such as cardiotocography, real-time ultrasonography, and maternal perception help to identify a fetus that is sub optimally oxygenated, with a significant degree of placental or acidemia dysfunction. These techniques allow us to intervene and prevent a progressive acidosis from ending in stillbirth.
The "Non- Stress Test" (NST) is one of the fetal well-being evaluation tests used during the prenatal period.
• This test uses the fetal heart rate (FHR), at which its baseline, accelerations, combined (15 beats in 15 seconds), associated with fetal movements or auditory stimulation, as well as decelerations associated with uterine contractions are evaluated. .
Fetal biophysical profile-consists of four real-time ultrasonographic observations where the following are evaluated:
• Fetal respiratory movements- one movement or more than 30 seconds in a 30-minute period• Fetal movements- three or more body or limb movements in a 30-minute period• Fetal tone- one or more episodes of extension with return to flexion of a limb or opening and closing of a hand
• Determination of amniotic fluid volume.
The objective is to review the guidelines to help identify the fetuses at risk to develop intrauterine death or developing neurologic complications from slowly developing intrauterine hypoxia and intervene to prevent these adverse outcomes, if possible.
Conditions for which antepartum evaluation is considered for payment:
• In certain high-risk conditions, testing can start as early as 28 weeks. The implications of a non-reassuring test are unclear before 28 weeks.
• When the condition causing the test persists, a reassuring ("reactive") test may be repeated periodically until delivery. An interval of 7 days between tests is considered adequate in the presence of reassuring ("reactive") results. This will give 8 false negatives/1000 tests. With certain maternal complications, a shorter interval may be considered.
N/A
BlueCard/National Account Issues
N/A
Studies in animal models have demonstrated that fetal biophysical activities (eg., heart rate, movements, breathing, tone) are sensitive to fetal oxygen and pH levels and changes in fetal biophysical activities occur in response to, or in association with, hypoxemia and acidemia. However fetal biophysical parameters can be affected by factors unrelated to hypoxemia, such as gestational age, maternal medication, maternal smoking, fetal sleep-wake, and fetal disease/anomalies.
Antepartum fetal assessment has had an established role in obstetric practice since the 1970s, although its ability to improve pregnancy outcome has not been evaluated by large, well-designed randomized trials. Efficacy is based on (1) observational studies that reported lower rates of fetal death in pregnancies that underwent fetal testing than among historic controls with the same indication for testing but no fetal testing and (2) the same or lower rates of fetal death in tested pregnancies (primarily high risk) than in a contemporary untested general obstetric population (primarily low risk).
N/A
Tests for antepartum fetal assessment are based on the premise that the fetus responds slowly progressive (chronic) hypoxemia with a detectable sequence of biophysical changes, beginning with signs of physiological adaptation and potentially ending with signs of physiological decompensation.
Population Reference No.
| Population Reference No. 1 Policy Statement | [X] MedicallyNecessary | [ ] Investigational | [ ] Not Medically Necessary |
N/A
The American College of Obstetricians and Gynecologists (ACOG) practice bulletin on antepartum fetal assessment is the good practice standard in the United States. The bulletin suggests antepartum testing for pregnancies in wich the risk of antepartumfetal demise is increased.
N/A
1. ACOG Practice Bulletin, Antepartum Fetal Surveillance, Number 9, October 1999 (Reaffirmed 2009)
2. De Vries JI, Fong BF. Normal fetal motility: an overview. Ultrasound Obstet Gynecol 2006; 27:701.
4. Practice bulletin no. 145: antepartum fetal surveillance. Obstet Gynecol 2014; 124:182.
| Codes | Number | Description |
| CPT | 59020 | Fetal contraction stress test |
| | 59025 | Fetal "non-stress test". |
| ICD-10 CM | E10.10 | Type 1 diabetes mellitus with ketoacidosis without coma |
| | E10.11 | Type 1 diabetes mellitus with ketoacidosis with coma |
| | E10.21 |
|
| | E10.22 | Type 1 diabetes mellitus with diabetic chronic kidney disease |
| | E10.29 | Type 1 diabetes mellitus with other diabetic kidney complication |
| | E10.311 | Type 1 diabetes mellitus with unspecified diabetic retinopathy with macular edema |
| | E10.319 | Type 1 diabetes mellitus with unspecified diabetic retinopathy without macular edema |
| | E10.3211 | Type 1 diabetes mellitus with mild nonproliferative diabetic retinopathy with macular edema, right eye |
| | E10.3212 | Type 1 diabetes mellitus with mild nonproliferative diabetic retinopathy with macular edema, left eye |
| | E10.3213 | Type 1 diabetes mellitus with mild nonproliferative diabetic retinopathy with macular edema, bilateral |
| | E10.3219 | Type 1 diabetes mellitus with mild nonproliferative diabetic retinopathy with macular edema, unspecified eye |
| | E10.3291 | Type 1 diabetes mellitus with mild nonproliferative diabetic retinopathy without macular edema, right eye |
| | E10.3292 | Type 1 diabetes mellitus with mild nonproliferative diabetic retinopathy without macular edema, left eye |
| | E10.3293 | Type 1 diabetes mellitus with mild nonproliferative diabetic retinopathy without macular edema, bilateral |
| | E10.3299 | Type 1 diabetes mellitus with mild nonproliferative diabetic retinopathy without macular edema, unspecified eye |
| | E10.3311 | Type 1 diabetes mellitus with moderate nonproliferative diabetic retinopathy with macular edema, right eye |
| | E10.3312 | Type 1 diabetes mellitus with moderate nonproliferative diabetic retinopathy with macular edema, left eye |
| | E10.3313 | Type 1 diabetes mellitus with moderate nonproliferative diabetic retinopathy with macular edema, bilateral |
| | E10.3319 | Type 1 diabetes mellitus with moderate nonproliferative diabetic retinopathy with macular edema, unspecified eye |
| | E10.3391 | Type 1 diabetes mellitus with moderate nonproliferative diabetic retinopathy without macular edema, right eye |
| | E10.3392 | Type 1 diabetes mellitus with moderate nonproliferative diabetic retinopathy without macular edema, left eye |
| | E10.3393 | Type 1 diabetes mellitus with moderate nonproliferative diabetic retinopathy without macular edema, bilateral |
| | E10.3399 | Type 1 diabetes mellitus with moderate nonproliferative diabetic retinopathy without macular edema, unspecified ey |
| | E10.3411 | Type 1 diabetes mellitus with severe nonproliferative diabetic retinopathy with macular edema, right eye |
| | E10.3412 | Type 1 diabetes mellitus with severe nonproliferative diabetic retinopathy with macular edema, left eye |
| | E10.3413 | Type 1 diabetes mellitus with severe nonproliferative diabetic retinopathy with macular edema, bilateral |
| | E10.3419 | Type 1 diabetes mellitus with severe nonproliferative diabetic retinopathy with macular edema, unspecified eye |
| | E10.3491 | Type 1 diabetes mellitus with severe nonproliferative diabetic retinopathy without macular edema, right eye |
| | E10.3492 | Type 1 diabetes mellitus with severe nonproliferative diabetic retinopathy without macular edema, left eye |
| | E10.3493 | Type 1 diabetes mellitus with severe nonproliferative diabetic retinopathy without macular edema, bilateral |
| | E10.3499 | Type 1 diabetes mellitus with severe nonproliferative diabetic retinopathy without macular edema, unspecified eye |
| | E10.3511 | Type 1 diabetes mellitus with proliferative diabetic retinopathy with macular edema, right eye |
| | E10.3512 | Type 1 diabetes mellitus with proliferative diabetic retinopathy with macular edema, left eye |
| | E10.3513 | Type 1 diabetes mellitus with proliferative diabetic retinopathy with macular edema, bilateral |
| | E10.3519 | Type 1 diabetes mellitus with proliferative diabetic retinopathy with macular edema, unspecified eye |
| | E10.3591 | Type 1 diabetes mellitus with proliferative diabetic retinopathy without macular edema, right eye |
| | E10.3592 | Type 1 diabetes mellitus with proliferative diabetic retinopathy without macular edema, left eye |
| | E10.3593 | Type 1 diabetes mellitus with proliferative diabetic retinopathy without macular edema, bilateral |
| | E10.3599 | Type 1 diabetes mellitus with proliferative diabetic retinopathy without macular edema, unspecified eye |
| | E10.36 | Type 1 diabetes mellitus with diabetic cataract |
| | E10.39 | Type 1 diabetes mellitus with other diabetic ophthalmic complication |
| | E10.40 | Type 1 diabetes mellitus with diabetic neuropathy, unspecified |
| | E10.41 | Type 1 diabetes mellitus with diabetic mononeuropathy |
| | E10.42 | Type 1 diabetes mellitus with diabetic polyneuropathy |
| | E10.43 | Type 1 diabetes mellitus with diabetic autonomic (poly)neuropathy |
| | E10.44 | Type 1 diabetes mellitus with diabetic amyotrophy |
| | E10.49 | Type 1 diabetes mellitus with other diabetic neurological complication |
| | E1051 | Type 1 diabetes mellitus with diabetic peripheral angiopathy without gangrene |
| | E10.52 | Type 1 diabetes mellitus with diabetic peripheral angiopathy with gangrene |
| | E10.59 | Type 1 diabetes mellitus with other circulatory complications |
| | E10.610 | Type 1 diabetes mellitus with diabetic neuropathic arthropathy |
| | E10.618 | Type 1 diabetes mellitus with other diabetic arthropathy |
| | E10.620 | Type 1 diabetes mellitus with diabetic dermatitis |
| | E10.621 | Type 1 diabetes mellitus with foot ulcer |
| | E10.622 | Type 1 diabetes mellitus with other skin ulcer |
| | E10.628 | Type 1 diabetes mellitus with other skin complications |
| | E10.630 | Type 1 diabetes mellitus with periodontal disease |
| | E10.638 | Type 1 diabetes mellitus with other oral complications |
| | E10.641 | Type 1 diabetes mellitus with hypoglycemia with coma |
| | E10.649 | Type 1 diabetes mellitus with hypoglycemia without coma |
| | E10.65 | Type 1 diabetes mellitus with hyperglycemia |
| | E10.69 | Type 1 diabetes mellitus with other specified complication |
| | E10.8 | Type 1 diabetes mellitus with unspecified complications |
| | E10.9 | Type 1 diabetes mellitus without complications |
| | E11.00 | Type 2 diabetes mellitus with hyperosmolarity without nonketotic hyperglycemic-hyperosmolar coma (NKHHC) |
| | E11.01 | Type 2 diabetes mellitus with hyperosmolarity with coma |
| | E1121 | Type 2 diabetes mellitus with diabetic nephropathy |
| | E1122 | Type 2 diabetes mellitus with diabetic chronic kidney disease |
| | E1129 | Type 2 diabetes mellitus with other diabetic kidney complication |
| | E11311 | Type 2 diabetes mellitus with unspecified diabetic retinopathy with macular edema |
| | E11319 | Type 2 diabetes mellitus with unspecified diabetic retinopathy without macular edema |
| | E11.3211 | Type 2 diabetes mellitus with mild nonproliferative diabetic retinopathy with macular edema, right eye |
| | E11.3212 | Type 2 diabetes mellitus with mild nonproliferative diabetic retinopathy with macular edema, left eye |
| | E11.3213 | Type 2 diabetes mellitus with mild nonproliferative diabetic retinopathy with macular edema, bilateral |
| | E11.3219 | Type 2 diabetes mellitus with mild nonproliferative diabetic retinopathy with macular edema, unspecified eye |
| | E11.3291 | Type 2 diabetes mellitus with mild nonproliferative diabetic retinopathy without macular edema, right eye |
| | E11.3292 | Type 2 diabetes mellitus with mild nonproliferative diabetic retinopathy without macular edema, left eye |
| | E11.3293 | Type 2 diabetes mellitus with mild nonproliferative diabetic retinopathy without macular edema, bilateral |
| | E11.3299 | Type 2 diabetes mellitus with mild nonproliferative diabetic retinopathy without macular edema, unspecified eye |
| | E11.3311 | Type 2 diabetes mellitus with moderate nonproliferative diabetic retinopathy with macular edema, right eye |
| | E11.3312 | Type 2 diabetes mellitus with moderate nonproliferative diabetic retinopathy with macular edema, left eye |
| | E11.3313 | Type 2 diabetes mellitus with moderate nonproliferative diabetic retinopathy with macular edema, bilateral |
| | E11.3319 | Type 2 diabetes mellitus with moderate nonproliferative diabetic retinopathy with macular edema, unspecified eye |
| | E11.3391 | Type 2 diabetes mellitus with moderate nonproliferative diabetic retinopathy without macular edema, right eye |
| | E11.3392 | Type 2 diabetes mellitus with moderate nonproliferative diabetic retinopathy without macular edema, left eye |
| | E11.3393 | Type 2 diabetes mellitus with moderate nonproliferative diabetic retinopathy without macular edema, bilateral |
| | E11.3399 | Type 2 diabetes mellitus with moderate nonproliferative diabetic retinopathy without macular edema, unspecified eye |
| | E11.3411 | Type 2 diabetes mellitus with severe nonproliferative diabetic retinopathy with macular edema, right eye |
| | E11.3412 | Type 2 diabetes mellitus with severe nonproliferative diabetic retinopathy with macular edema, left eye |
| | E11.3413 | Type 2 diabetes mellitus with severe nonproliferative diabetic retinopathy with macular edema, bilateral |
| | E11.3419 | Type 2 diabetes mellitus with severe nonproliferative diabetic retinopathy with macular edema, unspecified eye |
| | E11.3491 | Type 2 diabetes mellitus with severe nonproliferative diabetic retinopathy without macular edema, right eye |
| | E11.3492 | Type 2 diabetes mellitus with severe nonproliferative diabetic retinopathy without macular edema, left eye |
| | E11.3493 | Type 2 diabetes mellitus with severe nonproliferative diabetic retinopathy without macular edema, bilateral |
| | E11.3499 | Type 2 diabetes mellitus with severe nonproliferative diabetic retinopathy without macular edema, unspecified eye |
| | E11.3511 | Type 2 diabetes mellitus with proliferative diabetic retinopathy with macular edema, right eye |
| | E11.3512 | Type 2 diabetes mellitus with proliferative diabetic retinopathy with macular edema, left eye |
| | E11.3513 | Type 2 diabetes mellitus with proliferative diabetic retinopathy with macular edema, bilateral |
| | E11.3519 | Type 2 diabetes mellitus with proliferative diabetic retinopathy with macular edema, unspecified eye |
| | E11.3591 | Type 2 diabetes mellitus with proliferative diabetic retinopathy without macular edema, right eye |
| | E11.3592 | Type 2 diabetes mellitus with proliferative diabetic retinopathy without macular edema, left eye |
| | E11.3593 | Type 2 diabetes mellitus with proliferative diabetic retinopathy without macular edema, bilateral |
| | E11.3599 | Type 2 diabetes mellitus with proliferative diabetic retinopathy without macular edema, unspecified eye |
| | E11.36 | Type 2 diabetes mellitus with diabetic cataract |
| | E11.39 | Type 2 diabetes mellitus with other diabetic ophthalmic complication |
| | E11.40 | Type 2 diabetes mellitus with diabetic neuropathy, unspecified |
| | E11.41 | Type 2 diabetes mellitus with diabetic mononeuropathy |
| | E11.42 | Type 2 diabetes mellitus with diabetic polyneuropathy |
| | E11.43 | Type 2 diabetes mellitus with diabetic autonomic (poly)neuropathy |
| | E11.44 | Type 2 diabetes mellitus with diabetic amyotrophy |
| | E11.49 | Type 2 diabetes mellitus with other diabetic neurological complication |
| | E11.51 | Type 2 diabetes mellitus with diabetic peripheral angiopathy without gangrene |
| | E11.52 | Type 2 diabetes mellitus with diabetic peripheral angiopathy with gangrene |
| | E11.59 | Type 2 diabetes mellitus with other circulatory complications |
| | E11.610 | Type 2 diabetes mellitus with diabetic neuropathic arthropathy |
| | E11.618 | Type 2 diabetes mellitus with other diabetic arthropathy |
| | E11.620 | Type 2 diabetes mellitus with diabetic dermatitis |
| | E11.621 | Type 2 diabetes mellitus with foot ulcer |
| | E11.622 | Type 2 diabetes mellitus with other skin ulcer |
| | E11.628 | Type 2 diabetes mellitus with other skin complications |
| | E11.630 | Type 2 diabetes mellitus with periodontal disease |
| | E11.638 | Type 2 diabetes mellitus with other oral complications |
| | E11.641 | Type 2 diabetes mellitus with hypoglycemia with coma |
| | E11.649 | Type 2 diabetes mellitus with hypoglycemia without coma |
| | E11.65 | Type 2 diabetes mellitus with hyperglycemia |
| | E11.69 | Type 2 diabetes mellitus with other specified complication |
| | E11.8 | Type 2 diabetes mellitus with unspecified complications |
| | E11.9 | Type 2 diabetes mellitus without complications |
| | E13.00 | Other specified diabetes mellitus with hyperosmolarity without nonketotic hyperglycemic-hyperosmolar coma (NKHHC) |
| | E13.01 | Other specified diabetes mellitus with hyperosmolarity with coma |
| | E13.10 | Other specified diabetes mellitus with ketoacidosis without coma |
| | E13.11 | Other specified diabetes mellitus with ketoacidosis with coma |
| | E13.21 | Other specified diabetes mellitus with diabetic nephropathy |
| | E13.22 |
|
| | E13.29 | Other specified diabetes mellitus with other diabetic kidney complication |
| | E13.311 | Other specified diabetes mellitus with unspecified diabetic retinopathy with macular edema |
| | E13.319 | Other specified diabetes mellitus with unspecified diabetic retinopathy without macular edema |
| | E13.3211 | Other specified diabetes mellitus with mild nonproliferative diabetic retinopathy with macular edema, right eye |
| | E13.3212 | Other specified diabetes mellitus with mild nonproliferative diabetic retinopathy with macular edema |
| | E13.3213 | Other specified diabetes mellitus with mild nonproliferative diabetic retinopathy with macular edema, bilatera |
| | E13.3219 | Other specified diabetes mellitus with mild nonproliferative diabetic retinopathy with macular edema, unspecified eye |
| | E13.3291 | Other specified diabetes mellitus with mild nonproliferative diabetic retinopathy without macular edema, right eye |
| | E13.3292 | Other specified diabetes mellitus with mild nonproliferative diabetic retinopathy without macular edema, left eye |
| | E13.3293 | Other specified diabetes mellitus with mild nonproliferative diabetic retinopathy without macular edema, bilateral |
| | E13.3299 | Other specified diabetes mellitus with mild nonproliferative diabetic retinopathy without macular edema, unspecified eye |
| | E13.3311 |
|
| | E13.3312 | Other specified diabetes mellitus with moderate nonproliferative diabetic retinopathy with macular edema, left eye |
| | E13.3313 | Other specified diabetes mellitus with moderate nonproliferative diabetic retinopathy with macular edema, bilateral |
| | E13.3319 | Other specified diabetes mellitus with moderate nonproliferative diabetic retinopathy with macular edema, unspecified eye |
| | E13.3391 | Other specified diabetes mellitus with moderate nonproliferative diabetic retinopathy without macular edema, right eye |
| | E13.3392 | Other specified diabetes mellitus with moderate nonproliferative diabetic retinopathy without macular edema, left eye |
| | E13.3393 | Other specified diabetes mellitus with moderate nonproliferative diabetic retinopathy without macular edema, bilateral |
| | E13.3399 | Other specified diabetes mellitus with moderate nonproliferative diabetic retinopathy without macular edema, unspecified eye |
| | E13.3411 | Other specified diabetes mellitus with severe nonproliferative diabetic retinopathy with macular edema, right eye |
| | E13.3412 | Other specified diabetes mellitus with severe nonproliferative diabetic retinopathy with macular edema, left eye |
| | E13.3413 | Other specified diabetes mellitus with severe nonproliferative diabetic retinopathy with macular edema, bilateral |
| | E13.3419 | Other specified diabetes mellitus with severe nonproliferative diabetic retinopathy with macular edema, unspecified eye |
| | E13.3491 | Other specified diabetes mellitus with severe nonproliferative diabetic retinopathy without macular edema, right eye |
| | E13.3492 | Other specified diabetes mellitus with severe nonproliferative diabetic retinopathy without macular edema, left eye |
| | E13.3493 | Other specified diabetes mellitus with severe nonproliferative diabetic retinopathy without macular edema, bilateral |
| | E13.3499 | Other specified diabetes mellitus with severe nonproliferative diabetic retinopathy without macular edema, unspecified eye |
| | E13.3511 | Other specified diabetes mellitus with proliferative diabetic retinopathy with macular edema, right eye |
| | E13.3512 | Other specified diabetes mellitus with proliferative diabetic retinopathy with macular edema, left eye |
| | E13.3513 | Other specified diabetes mellitus with proliferative diabetic retinopathy with macular edema, bilateral |
| | E13.3519 | Other specified diabetes mellitus with proliferative diabetic retinopathy with macular edema, unspecified eye |
| | E13.3591 | Other specified diabetes mellitus with proliferative diabetic retinopathy without macular edema, right eye |
| | E13.3592 | Other specified diabetes mellitus with proliferative diabetic retinopathy without macular edema, left eye |
| | E13.3593 | Other specified diabetes mellitus with proliferative diabetic retinopathy without macular edema, bilateral |
| | E13.3599 | Other specified diabetes mellitus with proliferative diabetic retinopathy without macular edema, unspecified eye |
| | E13.36 | Other specified diabetes mellitus with diabetic cataract |
| | E13.39 | Other specified diabetes mellitus with other diabetic ophthalmic complication |
| | E13.40 | Other specified diabetes mellitus with diabetic neuropathy, unspecified |
| | E13.41 | Other specified diabetes mellitus with diabetic mononeuropathy |
| | E13.42 | Other specified diabetes mellitus with diabetic polyneuropathy |
| | E13.43 | Other specified diabetes mellitus with diabetic autonomic (poly)neuropathy |
| | E13.44 | Other specified diabetes mellitus with diabetic amyotrophy |
| | E13.49 | Other specified diabetes mellitus with other diabetic neurological complication |
| | E13.51 | Other specified diabetes mellitus with diabetic peripheral angiopathy without gangrene |
| | E13.52 | Other specified diabetes mellitus with diabetic peripheral angiopathy with gangrene |
| | E13.59 | Other specified diabetes mellitus with other circulatory complications |
| | E13.610 | Other specified diabetes mellitus with diabetic neuropathic arthropathy |
| | E13.618 | Other specified diabetes mellitus with other diabetic arthropathy |
| | E13.620 | Other specified diabetes mellitus with diabetic dermatitis |
| | E13.621 | Other specified diabetes mellitus with foot ulcer |
| | E13.622 | Other specified diabetes mellitus with other skin ulcer |
| | E13.628 | Other specified diabetes mellitus with other skin complications |
| | E13.630 |
|
| | E13.638 | Other specified diabetes mellitus with other oral complications |
| | E13.641 | Other specified diabetes mellitus with hypoglycemia with coma |
| | E13.649 | Other specified diabetes mellitus with hypoglycemia without coma |
| | E13.65 | Other specified diabetes mellitus with hyperglycemia |
| | E13.69 | Other specified diabetes mellitus with other specified complication |
| | E13.8 | Other specified diabetes mellitus with unspecified complications |
| | E13.9 | Other specified diabetes mellitus without complications |
| | M32.0 | Drug-induced systemic lupus erythematosus |
| | M32.10 | Systemic lupus erythematosus, organ or system involvement unspecified |
| | M32.11 | Endocarditis in systemic lupus erythematosus |
| | M32.12 | Pericarditis in systemic lupus erythematosus |
| | M32.13 | Lung involvement in systemic lupus erythematosus |
| | M32.14 | Glomerular disease in systemic lupus erythematosus |
| | M32.15 | Tubulo-interstitial nephropathy in systemic lupus erythematosus |
| | M32.19 | Other organ or system involvement in systemic lupus erythematosus |
| | M32.8 | Other forms of systemic lupus erythematosus |
| | M32.9 | Systemic lupus erythematosus, unspecified |
| | O09.521 | Supervision of elderly multigravida, first trimester |
| | O09.522 | Supervision of elderly multigravida, second trimester |
| | O09.523 | Supervision of elderly multigravida, third trimester |
| | O09.529 | Supervision of elderly multigravida, unspecified trimester |
| | O09.891 | Supervision of other high risk pregnancies, first trimester |
| | O09.892 | Supervision of other high risk pregnancies, second trimester |
| | O09.893 | Supervision of other high risk pregnancies, third trimester |
| | O09.899 | Supervision of other high risk pregnancies, unspecified trimester |
| | O09.90 | Supervision of high risk pregnancy, unspecified, unspecified trimester |
| | O09.91 | Supervision of high risk pregnancy, unspecified, first trimester |
| | O09.92 | Supervision of high risk pregnancy, unspecified, second trimester |
| | O09.93 | Supervision of high risk pregnancy, unspecified, third trimester |
| | O10.011 | Pre-existing essential hypertension complicating pregnancy, first trimester |
| | O10.012 | Pre-existing essential hypertension complicating pregnancy, second trimester |
| | O10.013 | Pre-existing essential hypertension complicating pregnancy, third trimester |
| | O10.019 | Pre-existing essential hypertension complicating pregnancy, unspecified trimester |
| | O10.02 | Pre-existing essential hypertension complicating childbirth |
| | O10.111 | Pre-existing hypertensive heart disease complicating pregnancy, first trimester |
| | O10.112 | Pre-existing hypertensive heart disease complicating pregnancy, second trimester |
| | O10.113 | Pre-existing hypertensive heart disease complicating pregnancy, third trimester |
| | O10.119 | Pre-existing hypertensive heart disease complicating pregnancy, unspecified trimester |
| | O10.12 | Pre-existing hypertensive heart disease complicating childbirth |
| | O10.13 | Pre-existing hypertensive heart disease complicating the puerperium |
| | O10.211 | Pre-existing hypertensive chronic kidney disease complicating pregnancy, first trimester |
| | O10.212 | Pre-existing hypertensive chronic kidney disease complicating pregnancy, second trimester |
| | O10.213 | Pre-existing hypertensive chronic kidney disease complicating pregnancy, third trimester |
| | O10.219 | Pre-existing hypertensive chronic kidney disease complicating pregnancy, unspecified trimester |
| | O10.22 | Pre-existing hypertensive chronic kidney disease complicating childbirth |
| | O10.23 | Pre-existing hypertensive chronic kidney disease complicating the puerperium |
| | O10.311 | Pre-existing hypertensive heart and chronic kidney disease complicating pregnancy, first trimester |
| | O10.312 | Pre-existing hypertensive heart and chronic kidney disease complicating pregnancy, second trimester |
| | O10.313 | Pre-existing hypertensive heart and chronic kidney disease complicating pregnancy, third trimester |
| | O10.319 | Pre-existing hypertensive heart and chronic kidney disease complicating pregnancy, unspecified trimester |
| | O10.32 | Pre-existing hypertensive heart and chronic kidney disease complicating childbirth |
| | O10.33 | Pre-existing hypertensive heart and chronic kidney disease complicating the puerperium |
| | O10.411 | Pre-existing secondary hypertension complicating pregnancy, first trimester |
| | O10.412 | Pre-existing secondary hypertension complicating pregnancy, second trimester |
| | O10.413 | Pre-existing secondary hypertension complicating pregnancy, third trimester |
| | O10.419 | Pre-existing secondary hypertension complicating pregnancy, unspecified trimester |
| | O10.42 | Pre-existing secondary hypertension complicating childbirth |
| | O10.43 | Pre-existing secondary hypertension complicating the puerperium |
| | O10.911 | Unspecified pre-existing hypertension complicating pregnancy, first trimester |
| | O10.912 | Unspecified pre-existing hypertension complicating pregnancy, second trimester |
| | O10.913 | Unspecified pre-existing hypertension complicating pregnancy, third trimester |
| | O10.919 | Unspecified pre-existing hypertension complicating pregnancy, unspecified trimester |
| | O10.92 | Unspecified pre-existing hypertension complicating childbirth |
| | O10.93 | Unspecified pre-existing hypertension complicating the puerperium |
| | O11.1 | Pre-existing hypertension with pre-eclampsia, first trimester |
| | O11.2 | Pre-existing hypertension with pre-eclampsia, second trimester |
| | O11.3 | Pre-existing hypertension with pre-eclampsia, third trimester |
| | O11.9 | Pre-existing hypertension with pre-eclampsia, unspecified trimester |
| | O13.1 | Gestational [pregnancy-induced] hypertension without significant proteinuria, first trimester |
| | O13.2 | Gestational [pregnancy-induced] hypertension without significant proteinuria, second trimester |
| | O13.3 | Gestational [pregnancy-induced] hypertension without significant proteinuria, third trimester |
| | O13.9 | Gestational [pregnancy-induced] hypertension without significant proteinuria, unspecified trimester |
| | O14.00 | Mild to moderate pre-eclampsia, unspecified trimester |
| | O14.02 | Mild to moderate pre-eclampsia, second trimester |
| | O14.03 | Mild to moderate pre-eclampsia, third trimester |
| | O14.10 | Severe pre-eclampsia, unspecified trimester |
| | O14.12 | Severe pre-eclampsia, second trimester |
| | O14.13 | Severe pre-eclampsia, third trimester |
| | O14.20 | HELLP syndrome (HELLP), unspecified trimester |
| | O14.22 | HELLP syndrome (HELLP), second trimester |
| | O14.23 | HELLP syndrome (HELLP), third trimester |
| | O14.90 | Unspecified pre-eclampsia, unspecified trimester |
| | O14.92 | Unspecified pre-eclampsia, second trimester |
| | O14.93 |
|
| | O15.00 | Eclampsia complicating pregnancy, unspecified trimester |
| | O15.02 | Eclampsia complicating pregnancy, second trimester |
| | O15.03 | Eclampsia complicating pregnancy, third trimester |
| | O15.1 | Eclampsia complicating labor |
| | O15.2 | Eclampsia complicating the puerperium |
| | O15.9 | Eclampsia, unspecified as to time period |
| | O16.1 | Unspecified maternal hypertension, first trimester |
| | O16.2 |
|
| | O16.3 | Unspecified maternal hypertension, third trimester |
| | O16.9 | Unspecified maternal hypertension, unspecified trimester |
| | O20.0 | Threatened abortion |
| | O20.8 | Other hemorrhage in early pregnancy |
| | O20.9 | Hemorrhage in early pregnancy, unspecified |
| | O24.011 | Pre-existing type 1 diabetes mellitus, in pregnancy, first trimester |
| | O24.012 | Pre-existing type 1 diabetes mellitus, in pregnancy, second trimester |
| | O24.013 | Pre-existing type 1 diabetes mellitus, in pregnancy, third trimester |
| | O24.111 | Pre-existing type 2 diabetes mellitus, in pregnancy, first trimester |
| | O24.112 | Pre-existing type 2 diabetes mellitus, in pregnancy, second trimester |
| | O24.113 | Pre-existing type 2 diabetes mellitus, in pregnancy, third trimester |
| | O24.311 | Unspecified pre-existing diabetes mellitus in pregnancy, first trimester |
| | O24.312 | Unspecified pre-existing diabetes mellitus in pregnancy, second trimester |
| | O24.313 | Unspecified pre-existing diabetes mellitus in pregnancy, third trimester |
| | O24.319 | Unspecified pre-existing diabetes mellitus in pregnancy, unspecified trimester |
| | O24.410 | Gestational diabetes mellitus in pregnancy, diet controlled |
| | O24.414 | Gestational diabetes mellitus in pregnancy, insulin controlled |
| | O24.419 | Gestational diabetes mellitus in pregnancy, unspecified control |
| | O24.811 | Other pre-existing diabetes mellitus in pregnancy, first trimester |
| | O24.812 | Other pre-existing diabetes mellitus in pregnancy, second trimester |
| | O24.813 | Other pre-existing diabetes mellitus in pregnancy, third trimester |
| | O24.819 | Other pre-existing diabetes mellitus in pregnancy, unspecified trimester |
| | O24.911 | Unspecified diabetes mellitus in pregnancy, first trimester |
| | O24.912 | Unspecified diabetes mellitus in pregnancy, second trimester |
| | O24.913 | Unspecified diabetes mellitus in pregnancy, third trimester |
| | O24.919 | Unspecified diabetes mellitus in pregnancy, unspecified trimester |
| | O30.001 | Twin pregnancy, unspecified number of placenta and unspecified number of amniotic sacs, first trimester |
| | O30.002 |
|
| | O30.003 | Twin pregnancy, unspecified number of placenta and unspecified number of amniotic sacs, third trimester |
| | O30.009 | Twin pregnancy, unspecified number of placenta and unspecified number of amniotic sacs, unspecified t |
| | O30.011 | Twin pregnancy, monochorionic/monoamniotic, first trimester |
| | O30.012 | Twin pregnancy, monochorionic/monoamniotic, second trimester |
| | O30.013 | Twin pregnancy, monochorionic/monoamniotic, third trimester |
| | O30.019 | Twin pregnancy, monochorionic/monoamniotic, unspecified trimester |
| | O30.031 |
|
| | O30.032 | Twin pregnancy, monochorionic/diamniotic, second trimester |
| | O30.033 | Twin pregnancy, monochorionic/diamniotic, third trimester |
| | O30.039 | Twin pregnancy, monochorionic/diamniotic, unspecified trimester |
| | O30.041 | Twin pregnancy, dichorionic/diamniotic, first trimester |
| | O30.042 | Twin pregnancy, dichorionic/diamniotic, second trimester |
| | O30.043 | Twin pregnancy, dichorionic/diamniotic, third trimester |
| | O30.049 |
|
| | O30.091 | Twin pregnancy, unable to determine number of placenta and number of amniotic sacs, first trimester |
| | O30.092 | Twin pregnancy, unable to determine number of placenta and number of amniotic sacs, second trimester |
| | O30.093 | Twin pregnancy, unable to determine number of placenta and number of amniotic sacs, third trimester |
| | O30.099 | Twin pregnancy, unable to determine number of placenta and number of amniotic sacs, unspecified trimester |
| | O30.101 | Triplet pregnancy, unspecified number of placenta and unspecified number of amniotic sacs, first trimester |
| | O30.102 | Triplet pregnancy, unspecified number of placenta and unspecified number of amniotic sacs, second trimester |
| | O30.103 | Triplet pregnancy, unspecified number of placenta and unspecified number of amniotic sacs, third trimester |
| | O30.109 | Triplet pregnancy, unspecified number of placenta and unspecified number of amniotic sacs, unspecified trimester |
| | O30.111 | Triplet pregnancy with two or more monochorionic fetuses, first trimester |
| | O30.112 | Triplet pregnancy with two or more monochorionic fetuses, second trimester |
| | O30.113 | Triplet pregnancy with two or more monochorionic fetuses, third trimester |
| | O30.119 | Triplet pregnancy with two or more monochorionic fetuses, unspecified trimeste |
| | O30.121 | Triplet pregnancy with two or more monoamniotic fetuses, first trimester |
| | O30.122 | Triplet pregnancy with two or more monoamniotic fetuses, second trimester |
| | O30.123 | Triplet pregnancy with two or more monoamniotic fetuses, third trimester |
| | O30.129 | Triplet pregnancy with two or more monoamniotic fetuses, unspecified trimester |
| | O30.191 | Triplet pregnancy, unable to determine number of placenta and number of amniotic sacs, first trimester |
| | O30.192 | Triplet pregnancy, unable to determine number of placenta and number of amniotic sacs, second trimester |
| | O30.193 | Triplet pregnancy, unable to determine number of placenta and number of amniotic sacs, third trimester |
| | O30.199 | Triplet pregnancy, unable to determine number of placenta and number of amniotic sacs, unspecified trimester |
| | O30.201 | Quadruplet pregnancy, unspecified number of placenta and unspecified number of amniotic sacs, first trimester |
| | O30.202 | Quadruplet pregnancy, unspecified number of placenta and unspecified number of amniotic sacs, second trimester |
| | O30.203 | Quadruplet pregnancy, unspecified number of placenta and unspecified number of amniotic sacs, third trimester |
| | O30.209 | Quadruplet pregnancy, unspecified number of placenta and unspecified number of amniotic sacs, unspecified trimester |
| | O30.211 | Quadruplet pregnancy with two or more monochorionic fetuses, first trimester |
| | O30.212 | Quadruplet pregnancy with two or more monochorionic fetuses, second trimester |
| | O30.213 | Quadruplet pregnancy with two or more monochorionic fetuses, third trimester |
| | O30.219 | Quadruplet pregnancy with two or more monochorionic fetuses, unspecified trimester |
| | O30.221 | Quadruplet pregnancy with two or more monoamniotic fetuses, first trimester |
| | O30.222 | Quadruplet pregnancy with two or more monoamniotic fetuses, second trimester |
| | O30.223 | Quadruplet pregnancy with two or more monoamniotic fetuses, third trimester |
| | O30.229 | Quadruplet pregnancy with two or more monoamniotic fetuses, unspecified trimester |
| | O30.291 | Quadruplet pregnancy, unable to determine number of placenta and number of amniotic sacs, first trimester |
| | O30.292 | Quadruplet pregnancy, unable to determine number of placenta and number of amniotic sacs, second trimester |
| | O30.293 | Quadruplet pregnancy, unable to determine number of placenta and number of amniotic sacs, third trimester |
| | O30.299 | Quadruplet pregnancy, unable to determine number of placenta and number of amniotic sacs, unspecified trimester |
| | O30.801 | Other specified multiple gestation, unspecified number of placenta and unspecified number of amniotic sacs, first trimester |
| | O30.802 | Other specified multiple gestation, unspecified number of placenta and unspecified number of amniotic sacs, second trimester |
| | O30.803 | Other specified multiple gestation, unspecified number of placenta and unspecified number of amniotic sacs, third trimester |
| | O30.809 | Other specified multiple gestation, unspecified number of placenta and unspecified number of amniotic sacs, unspecified trimester |
| | O30.811 | Other specified multiple gestation with two or more monochorionic fetuses, first trimester |
| | O30.812 | Other specified multiple gestation with two or more monochorionic fetuses, second trimester |
| | O30.813 | Other specified multiple gestation with two or more monochorionic fetuses, third trimester |
| | O30.819 | Other specified multiple gestation with two or more monochorionic fetuses, unspecified trimester |
| | O30.821 | Other specified multiple gestation with two or more monoamniotic fetuses, first trimester |
| | O30.822 | Other specified multiple gestation with two or more monoamniotic fetuses, second trimester |
| | O30.823 | Other specified multiple gestation with two or more monoamniotic fetuses, third trimester |
| | O30.829 | Other specified multiple gestation with two or more monoamniotic fetuses, unspecified trimester |
| | O30.891 | Other specified multiple gestation, unable to determine number of placenta and number of amniotic sacs, first trimester |
| | O30.892 | Other specified multiple gestation, unable to determine number of placenta and number of amniotic sacs, second trimester |
| | O30.893 | Other specified multiple gestation, unable to determine number of placenta and number of amniotic sacs, third trimester |
| | O30899 | Other specified multiple gestation, unable to determine number of placenta and number of amniotic sacs, unspecified trimester |
| | O30.90 | Multiple gestation, unspecified, unspecified trimester |
| | O30.91 | Multiple gestation, unspecified, first trimester |
| | O30.92 | Multiple gestation, unspecified, second trimester |
| | O30.93 | Multiple gestation, unspecified, third trimester |
| | O31.10X0 | Continuing pregnancy after spontaneous abortion of one fetus or more, unspecified trimester, not applicable or unspecified |
| | O31.10X1 | Continuing pregnancy after spontaneous abortion of one fetus or more, unspecified trimester, fetus 1 |
| | O31.10X2 | Continuing pregnancy after spontaneous abortion of one fetus or more, unspecified trimester, fetus 2 |
| | O31.10X3 | Continuing pregnancy after spontaneous abortion of one fetus or more, unspecified trimester, fetus 3 |
| | O31.10X4 | Continuing pregnancy after spontaneous abortion of one fetus or more, unspecified trimester, fetus 4 |
| | O31.10X5 | Continuing pregnancy after spontaneous abortion of one fetus or more, unspecified trimester, fetus 5 |
| | O31.10X9 | Continuing pregnancy after spontaneous abortion of one fetus or more, unspecified trimester, other fetus |
| | O31.11X0 | Continuing pregnancy after spontaneous abortion of one fetus or more, first trimester, not applicable or unspecified |
| | O31.11X1 | Continuing pregnancy after spontaneous abortion of one fetus or more, first trimester, fetus 1 |
| | O31.11X2 | Continuing pregnancy after spontaneous abortion of one fetus or more, first trimester, fetus 2 |
| | O31.11X3 | Continuing pregnancy after spontaneous abortion of one fetus or more, first trimester, fetus 3 |
| | O31.11X4 | Continuing pregnancy after spontaneous abortion of one fetus or more, first trimester, fetus 4 |
| | O31.11X5 | Continuing pregnancy after spontaneous abortion of one fetus or more, first trimester, fetus 5 |
| | O31.11X9 | Continuing pregnancy after spontaneous abortion of one fetus or more, first trimester, other fetus |
| | O31.12X0 | Continuing pregnancy after spontaneous abortion of one fetus or more, second trimester, not applicable or unspecified |
| | O31.12X1 | Continuing pregnancy after spontaneous abortion of one fetus or more, second trimester, fetus 1 |
| | O31.12X2 | Continuing pregnancy after spontaneous abortion of one fetus or more, second trimester, fetus 2 |
| | O31.12X3 | Continuing pregnancy after spontaneous abortion of one fetus or more, second trimester, fetus 3 |
| | O31.12X4 | Continuing pregnancy after spontaneous abortion of one fetus or more, second trimester, fetus 4 |
| | O31.12X5 | Continuing pregnancy after spontaneous abortion of one fetus or more, second trimester, fetus 5 |
| | O31.12X9 | Continuing pregnancy after spontaneous abortion of one fetus or more, second trimester, other fetus |
| | O31.13X0 | Continuing pregnancy after spontaneous abortion of one fetus or more, third trimester, not applicable or unspecified |
| | O31.13X1 | Continuing pregnancy after spontaneous abortion of one fetus or more, third trimester, fetus 1 |
| | O31.13X2 | Continuing pregnancy after spontaneous abortion of one fetus or more, third trimester, fetus 2 |
| | O31.13X3 | Continuing pregnancy after spontaneous abortion of one fetus or more, third trimester, fetus 3 |
| | O31.13X4 | Continuing pregnancy after spontaneous abortion of one fetus or more, third trimester, fetus 4 |
| | O31.13X5 | Continuing pregnancy after spontaneous abortion of one fetus or more, third trimester, fetus 5 |
| | O31.13X9 | Continuing pregnancy after spontaneous abortion of one fetus or more, third trimester, other fetus |
| | O31.20X0 | Continuing pregnancy after intrauterine death of one fetus or more, unspecified trimester, not applicable or unspecified |
| | O31.20X1 | Continuing pregnancy after intrauterine death of one fetus or more, unspecified trimester, fetus 1 |
| | O31.20X2 | Continuing pregnancy after intrauterine death of one fetus or more, unspecified trimester, fetus 2 |
| | O31.20X3 | Continuing pregnancy after intrauterine death of one fetus or more, unspecified trimester, fetus 3 |
| | O31.20X4 | Continuing pregnancy after intrauterine death of one fetus or more, unspecified trimester, fetus 4 |
| | O31.20X5 | Continuing pregnancy after intrauterine death of one fetus or more, unspecified trimester, fetus 5 |
| | O31.20X9 | Continuing pregnancy after intrauterine death of one fetus or more, unspecified trimester, other fetus |
| | O31.21X0 | Continuing pregnancy after intrauterine death of one fetus or more, first trimester, not applicable or unspecified |
| | O31.21X1 | Continuing pregnancy after intrauterine death of one fetus or more, first trimester, fetus 1 |
| | O31.21X2 | Continuing pregnancy after intrauterine death of one fetus or more, first trimester, fetus 2 |
| | O31.21X3 | Continuing pregnancy after intrauterine death of one fetus or more, first trimester, fetus 3 |
| | O31.21X4 | Continuing pregnancy after intrauterine death of one fetus or more, first trimester, fetus 4 |
| | O31.21X5 | Continuing pregnancy after intrauterine death of one fetus or more, first trimester, fetus 5 |
| | O31.21X9 | Continuing pregnancy after intrauterine death of one fetus or more, first trimester, other fetus |
| | O31.22X0 | Continuing pregnancy after intrauterine death of one fetus or more, second trimester, not applicable or unspecified |
| | O31.22X1 | Continuing pregnancy after intrauterine death of one fetus or more, second trimester, fetus 1 |
| | O31.22X2 | Continuing pregnancy after intrauterine death of one fetus or more, second trimester, fetus 2 |
| | O31.22X3 | Continuing pregnancy after intrauterine death of one fetus or more, second trimester, fetus 3 |
| | O31.22X4 | Continuing pregnancy after intrauterine death of one fetus or more, second trimester, fetus 4 |
| | O31.22X5 | Continuing pregnancy after intrauterine death of one fetus or more, second trimester, fetus 5 |
| | O31.22X9 | Continuing pregnancy after intrauterine death of one fetus or more, second trimester, other fetus |
| | O31.23X0 | Continuing pregnancy after intrauterine death of one fetus or more, third trimester, not applicable or unspecified |
| | O31.23X1 | Continuing pregnancy after intrauterine death of one fetus or more, third trimester, fetus 1 |
| | O31.23X2 | Continuing pregnancy after intrauterine death of one fetus or more, third trimester, fetus 2 |
| | O31.23X3 | Continuing pregnancy after intrauterine death of one fetus or more, third trimester, fetus 3 |
| | O31.23X4 | Continuing pregnancy after intrauterine death of one fetus or more, third trimester, fetus 4 |
| | O31.23X5 | Continuing pregnancy after intrauterine death of one fetus or more, third trimester, fetus 5 |
| | O31.23X9 | Continuing pregnancy after intrauterine death of one fetus or more, third trimester, other fetus |
| | O31.30X0 | Continuing pregnancy after elective fetal reduction of one fetus or more, unspecified trimester, not applicable or unspecified |
| | O31.30X1 | Continuing pregnancy after elective fetal reduction of one fetus or more, unspecified trimester, fetus 1 |
| | O31.30X2 | Continuing pregnancy after elective fetal reduction of one fetus or more, unspecified trimester, fetus 2 |
| | O31.30X3 | Continuing pregnancy after elective fetal reduction of one fetus or more, unspecified trimester, fetus 3 |
| | O31.30X4 | Continuing pregnancy after elective fetal reduction of one fetus or more, unspecified trimester, fetus 4 |
| | O31.30X5 | Continuing pregnancy after elective fetal reduction of one fetus or more, unspecified trimester, fetus 5 |
| | O31.30X9 | Continuing pregnancy after elective fetal reduction of one fetus or more, unspecified trimester, other fetus |
| | O31.31X0 | Continuing pregnancy after elective fetal reduction of one fetus or more, first trimester, not applicable or unspecified |
| | O31.31X1 | Continuing pregnancy after elective fetal reduction of one fetus or more, first trimester, fetus 1 |
| | O31.31X2 | Continuing pregnancy after elective fetal reduction of one fetus or more, first trimester, fetus 2 |
| | O31.31X3 | Continuing pregnancy after elective fetal reduction of one fetus or more, first trimester, fetus 3 |
| | O31.31X4 | Continuing pregnancy after elective fetal reduction of one fetus or more, first trimester, fetus 4 |
| | O31.31X5 | Continuing pregnancy after elective fetal reduction of one fetus or more, first trimester, fetus 5 |
| | O31.31X9 | Continuing pregnancy after elective fetal reduction of one fetus or more, first trimester, other fetus |
| | O31.32X0 | Continuing pregnancy after elective fetal reduction of one fetus or more, second trimester, not applicable or unspecified |
| | O31.32X1 | Continuing pregnancy after elective fetal reduction of one fetus or more, second trimester, fetus 1 |
| | O31.32X2 | Continuing pregnancy after elective fetal reduction of one fetus or more, second trimester, fetus 2 |
| | O31.32X3 | Continuing pregnancy after elective fetal reduction of one fetus or more, second trimester, fetus 3 |
| | O31.32X4 | Continuing pregnancy after elective fetal reduction of one fetus or more, second trimester, fetus 4 |
| | O31.32X5 | Continuing pregnancy after elective fetal reduction of one fetus or more, second trimester, fetus 5 |
| | O31.32X9 | Continuing pregnancy after elective fetal reduction of one fetus or more, second trimester, other fetus |
| | O31.33X0 | Continuing pregnancy after elective fetal reduction of one fetus or more, third trimester, not applicable or unspecified |
| | O31.33X1 | Continuing pregnancy after elective fetal reduction of one fetus or more, third trimester, fetus 1 |
| | O31.33X2 | Continuing pregnancy after elective fetal reduction of one fetus or more, third trimester, fetus 2 |
| | O31.33X3 | Continuing pregnancy after elective fetal reduction of one fetus or more, third trimester, fetus 3 |
| | O31.33X4 | Continuing pregnancy after elective fetal reduction of one fetus or more, third trimester, fetus 4 |
| | O31.33X5 | Continuing pregnancy after elective fetal reduction of one fetus or more, third trimester, fetus 5 |
| | O31.33X9 | Continuing pregnancy after elective fetal reduction of one fetus or more, third trimester, other fetus |
| | O31.8X10 | Other complications specific to multiple gestation, first trimester, not applicable or unspecified |
| | O31.8X11 | Other complications specific to multiple gestation, first trimester, fetus 1 |
| | O31.8X12 | Other complications specific to multiple gestation, first trimester, fetus 2 |
| | O31.8X13 | Other complications specific to multiple gestation, first trimester, fetus 3 |
| | O31.8X14 | Other complications specific to multiple gestation, first trimester, fetus 4 |
| | O31.8X15 | Other complications specific to multiple gestation, first trimester, fetus 5 |
| | O31.8X19 | Other complications specific to multiple gestation, first trimester, other fetus |
| | O318X20 | Other complications specific to multiple gestation, second trimester, not applicable or unspecified |
| | O318X21 | Other complications specific to multiple gestation, second trimester, fetus 1 |
| | O318X22 | Other complications specific to multiple gestation, second trimester, fetus 2 |
| | O318X23 | Other complications specific to multiple gestation, second trimester, fetus 3 |
| | O318X24 | Other complications specific to multiple gestation, second trimester, fetus 4 |
| | O318X25 | Other complications specific to multiple gestation, second trimester, fetus 5 |
| | O318X29 | Other complications specific to multiple gestation, second trimester, other fetus |
| | O318X30 | Other complications specific to multiple gestation, third trimester, not applicable or unspecified |
| | O318X31 | Other complications specific to multiple gestation, third trimester, fetus 1 |
| | O318X32 | Other complications specific to multiple gestation, third trimester, fetus 2 |
| | O318X33 | Other complications specific to multiple gestation, third trimester, fetus 3 |
| | O318X34 | Other complications specific to multiple gestation, third trimester, fetus 4 |
| | O318X35 | Other complications specific to multiple gestation, third trimester, fetus 5 |
| | O318X39 | Other complications specific to multiple gestation, third trimester, other fetus |
| | O318X90 | Other complications specific to multiple gestation, unspecified trimester, not applicable or unspecified |
| | O318X91 | Other complications specific to multiple gestation, unspecified trimester, fetus 1 |
| | O318X92 | Other complications specific to multiple gestation, unspecified trimester, fetus 2 |
| | O318X93 | Other complications specific to multiple gestation, unspecified trimester, fetus 3 |
| | O318X94 | Other complications specific to multiple gestation, unspecified trimester, fetus 4 |
| | O318X95 | Other complications specific to multiple gestation, unspecified trimester, fetus 5 |
| | O318X99 | Other complications specific to multiple gestation, unspecified trimester, other fetus |
| | O365110 | Maternal care for known or suspected placental insufficiency, first trimester, not applicable or unspecified |
| | O365111 | Maternal care for known or suspected placental insufficiency, first trimester, fetus 1 |
| | O365112 | Maternal care for known or suspected placental insufficiency, first trimester, fetus 2 |
| | O365113 | Maternal care for known or suspected placental insufficiency, first trimester, fetus 3 |
| | O365114 | Maternal care for known or suspected placental insufficiency, first trimester, fetus 4 |
| | O365115 | Maternal care for known or suspected placental insufficiency, first trimester, fetus 5 |
| | O365119 | Maternal care for known or suspected placental insufficiency, first trimester, other fetus |
| | O365120 | Maternal care for known or suspected placental insufficiency, second trimester, not applicable or unspecified |
| | O365121 | Maternal care for known or suspected placental insufficiency, second trimester, fetus 1 |
| | O365122 | Maternal care for known or suspected placental insufficiency, second trimester, fetus 2 |
| | O365123 | Maternal care for known or suspected placental insufficiency, second trimester, fetus 3 |
| | O365124 | Maternal care for known or suspected placental insufficiency, second trimester, fetus 4 |
| | O365125 | Maternal care for known or suspected placental insufficiency, second trimester, fetus 5 |
| | O365129 | Maternal care for known or suspected placental insufficiency, second trimester, other fetus |
| | O365130 | Maternal care for known or suspected placental insufficiency, third trimester, not applicable or unspecified |
| | O365131 | Maternal care for known or suspected placental insufficiency, third trimester, fetus 1 |
| | O365132 | Maternal care for known or suspected placental insufficiency, third trimester, fetus 2 |
| | O365133 | Maternal care for known or suspected placental insufficiency, third trimester, fetus 3 |
| | O365134 | Maternal care for known or suspected placental insufficiency, third trimester, fetus 4 |
| | O365135 | Maternal care for known or suspected placental insufficiency, third trimester, fetus 5 |
| | O365139 | Maternal care for known or suspected placental insufficiency, third trimester, other fetus |
| | O365190 | Maternal care for known or suspected placental insufficiency, unspecified trimester, not applicable or unspecified |
| | O365191 | Maternal care for known or suspected placental insufficiency, unspecified trimester, fetus 1 |
| | O365192 | Maternal care for known or suspected placental insufficiency, unspecified trimester, fetus 2 |
| | O365193 | Maternal care for known or suspected placental insufficiency, unspecified trimester, fetus 3 |
| | O365194 | Maternal care for known or suspected placental insufficiency, unspecified trimester, fetus 4 |
| | O365195 | Maternal care for known or suspected placental insufficiency, unspecified trimester, fetus 5 |
| | O365199 | Maternal care for known or suspected placental insufficiency, unspecified trimester, other fetus |
| | O365910 | Maternal care for other known or suspected poor fetal growth, first trimester, not applicable or unspecified |
| | O365911 | Maternal care for other known or suspected poor fetal growth, first trimester, fetus 1 |
| | O365912 | Maternal care for other known or suspected poor fetal growth, first trimester, fetus 2 |
| | O365913 | Maternal care for other known or suspected poor fetal growth, first trimester, fetus 3 |
| | O365914 | Maternal care for other known or suspected poor fetal growth, first trimester, fetus 4 |
| | O365915 | Maternal care for other known or suspected poor fetal growth, first trimester, fetus 5 |
| | O365919 | Maternal care for other known or suspected poor fetal growth, first trimester, other fetus |
| | O365920 | Maternal care for other known or suspected poor fetal growth, second trimester, not applicable or unspecified |
| | O365921 | Maternal care for other known or suspected poor fetal growth, second trimester, fetus 1 |
| | O365922 | Maternal care for other known or suspected poor fetal growth, second trimester, fetus 2 |
| | O365923 | Maternal care for other known or suspected poor fetal growth, second trimester, fetus 3 |
| | O365924 | Maternal care for other known or suspected poor fetal growth, second trimester, fetus 4 |
| | O365925 | Maternal care for other known or suspected poor fetal growth, second trimester, fetus 5 |
| | O365929 | Maternal care for other known or suspected poor fetal growth, second trimester, other fetus |
| | O365930 | Maternal care for other known or suspected poor fetal growth, third trimester, not applicable or unspecified |
| | O365931 | Maternal care for other known or suspected poor fetal growth, third trimester, fetus 1 |
| | O365932 | Maternal care for other known or suspected poor fetal growth, third trimester, fetus 2 |
| | O365933 | Maternal care for other known or suspected poor fetal growth, third trimester, fetus 3 |
| | O365934 | Maternal care for other known or suspected poor fetal growth, third trimester, fetus 4 |
| | O365935 | Maternal care for other known or suspected poor fetal growth, third trimester, fetus 5 |
| | O365939 | Maternal care for other known or suspected poor fetal growth, third trimester, other fetus |
| | O365990 | Maternal care for other known or suspected poor fetal growth, unspecified trimester, not applicable or unspecified |
| | O365991 | Maternal care for other known or suspected poor fetal growth, unspecified trimester, fetus 1 |
| | O365992 | Maternal care for other known or suspected poor fetal growth, unspecified trimester, fetus 2 |
| | O365993 | Maternal care for other known or suspected poor fetal growth, unspecified trimester, fetus 3 |
| | O365994 | Maternal care for other known or suspected poor fetal growth, unspecified trimester, fetus 4 |
| | O365995 | Maternal care for other known or suspected poor fetal growth, unspecified trimester, fetus 5 |
| | O365999 | Maternal care for other known or suspected poor fetal growth, unspecified trimester, other fetus |
| | O368120 | Decreased fetal movements, second trimester, not applicable or unspecified |
| | O368121 | Decreased fetal movements, second trimester, fetus 1 |
| | O368122 | Decreased fetal movements, second trimester, fetus 2 |
| | O368123 | Decreased fetal movements, second trimester, fetus 3 |
| | O368124 | Decreased fetal movements, second trimester, fetus 4 |
| | O368125 | Decreased fetal movements, second trimester, fetus 5 |
| | O368129 | Decreased fetal movements, second trimester, other fetus |
| | O368130 | Decreased fetal movements, third trimester, not applicable or unspecified |
| | O368131 | Decreased fetal movements, third trimester, fetus 1 |
| | O368132 | Decreased fetal movements, third trimester, fetus 2 |
| | O368133 | Decreased fetal movements, third trimester, fetus 3 |
| | O368134 | Decreased fetal movements, third trimester, fetus 4 |
| | O368135 | Decreased fetal movements, third trimester, fetus 5 |
| | O368139 | Decreased fetal movements, third trimester, other fetus |
| | O368190 | Decreased fetal movements, unspecified trimester, not applicable or unspecified |
| | O368191 | Decreased fetal movements, unspecified trimester, fetus 1 |
| | O368192 | Decreased fetal movements, unspecified trimester, fetus 2 |
| | O368193 | Decreased fetal movements, unspecified trimester, fetus 3 |
| | O368194 | Decreased fetal movements, unspecified trimester, fetus 4 |
| | O368195 | Decreased fetal movements, unspecified trimester, fetus 5 |
| | O368199 | Decreased fetal movements, unspecified trimester, other fetus |
| | O401XX0 | Polyhydramnios, first trimester, not applicable or unspecified |
| | O401XX1 | Polyhydramnios, first trimester, fetus 1 |
| | O401XX2 | Polyhydramnios, first trimester, fetus 2 |
| | O401XX3 | Polyhydramnios, first trimester, fetus 3 |
| | O401XX4 | Polyhydramnios, first trimester, fetus 4 |
| | O401XX5 | Polyhydramnios, first trimester, fetus 5 |
| | O401XX9 | Polyhydramnios, first trimester, other fetus |
| | O402XX0 | Polyhydramnios, second trimester, not applicable or unspecified |
| | O402XX1 | Polyhydramnios, second trimester, fetus 1 |
| | O402XX2 | Polyhydramnios, second trimester, fetus 2 |
| | O402XX3 | Polyhydramnios, second trimester, fetus 3 |
| | O402XX4 | Polyhydramnios, second trimester, fetus 4 |
| | O402XX5 | Polyhydramnios, second trimester, fetus 5 |
| | O402XX9 | Polyhydramnios, second trimester, other fetus |
| | O403XX0 | Polyhydramnios, third trimester, not applicable or unspecified |
| | O403XX1 | Polyhydramnios, third trimester, fetus 1 |
| | O403XX2 | Polyhydramnios, third trimester, fetus 2 |
| | O403XX3 | Polyhydramnios, third trimester, fetus 3 |
| | O403XX4 | Polyhydramnios, third trimester, fetus 4 |
| | O403XX5 | Polyhydramnios, third trimester, fetus 5 |
| | O403XX9 | Polyhydramnios, third trimester, other fetus |
| | O409XX0 | Polyhydramnios, unspecified trimester, not applicable or unspecified |
| | O409XX1 | Polyhydramnios, unspecified trimester, fetus 1 |
| | O409XX2 | Polyhydramnios, unspecified trimester, fetus 2 |
| | O409XX3 | Polyhydramnios, unspecified trimester, fetus 3 |
| | O409XX4 | Polyhydramnios, unspecified trimester, fetus 4 |
| | O409XX5 | Polyhydramnios, unspecified trimester, fetus 5 |
| | O409XX9 | Polyhydramnios, unspecified trimester, other fetus |
| | O4100X0 | Oligohydramnios, unspecified trimester, not applicable or unspecified |
| | O4100X1 | Oligohydramnios, unspecified trimester, fetus 1 |
| | O4100X2 | Oligohydramnios, unspecified trimester, fetus 2 |
| | O4100X3 | Oligohydramnios, unspecified trimester, fetus 3 |
| | O4100X4 | Oligohydramnios, unspecified trimester, fetus 4 |
| | O4100X5 | Oligohydramnios, unspecified trimester, fetus 5 |
| | O4100X9 | Oligohydramnios, unspecified trimester, other fetus |
| | O4101X0 | Oligohydramnios, first trimester, not applicable or unspecified |
| | O4101X1 | Oligohydramnios, first trimester, fetus 1 |
| | O4101X2 | Oligohydramnios, first trimester, fetus 2 |
| | O4101X3 | Oligohydramnios, first trimester, fetus 3 |
| | O4101X4 | Oligohydramnios, first trimester, fetus 4 |
| | O41.01X5 | Oligohydramnios, first trimester, fetus 5 |
| | O41.01X9 | Oligohydramnios, first trimester, other fetus |
| | O41.02X0 | Oligohydramnios, second trimester, not applicable or unspecified |
| | O41.02X1 | Oligohydramnios, second trimester, fetus 1 |
| | O41.02X2 | Oligohydramnios, second trimester, fetus 2 |
| | O41.02X3 | Oligohydramnios, second trimester, fetus 3 |
| | O41.02X4 | Oligohydramnios, second trimester, fetus 4 |
| | O41.02X5 | Oligohydramnios, second trimester, fetus 5 |
| | O41.02X9 | Oligohydramnios, second trimester, other fetus |
| | O41.03X0 | Oligohydramnios, third trimester, not applicable or unspecified |
| | O4103X1 | Oligohydramnios, third trimester, fetus 1 |
| | O41.03X2 | Oligohydramnios, third trimester, fetus 2 |
| | O41.03X3 | Oligohydramnios, third trimester, fetus 3 |
| | O41.03X4 | Oligohydramnios, third trimester, fetus 4 |
| | O41.03X5 | Oligohydramnios, third trimester, fetus 5 |
| | O41.03X9 | Oligohydramnios, third trimester, other fetus |
| | O44.00 | Complete placenta previa NOS or without hemorrhage, unspecified trimester |
| | O44.01 | Complete placenta previa NOS or without hemorrhage, first trimester |
| | O44.02 | Complete placenta previa NOS or without hemorrhage, second trimester |
| | O44.03 | Complete placenta previa NOS or without hemorrhage, third trimester |
| | O44.10 | Complete placenta previa with hemorrhage, unspecified trimester |
| | O44.11 | Complete placenta previa with hemorrhage, first trimester |
| | O44.12 | Complete placenta previa with hemorrhage, second trimester |
| | O44.13 | Complete placenta previa with hemorrhage, third trimester |
| | O45.001 | Premature separation of placenta with coagulation defect, unspecified, first trimester |
| | O45.002 | Premature separation of placenta with coagulation defect, unspecified, second trimester |
| | O45.003 | Premature separation of placenta with coagulation defect, unspecified, third trimester |
| | O45.009 | Premature separation of placenta with coagulation defect, unspecified, unspecified trimester |
| | O45.011 | Premature separation of placenta with afibrinogenemia, first trimester |
| | O45.012 | Premature separation of placenta with afibrinogenemia, second trimester |
| | O45.013 | Premature separation of placenta with afibrinogenemia, third trimester |
| | O45.019 | Premature separation of placenta with afibrinogenemia, unspecified trimester |
| | O45.021 | Premature separation of placenta with disseminated intravascular coagulation, first trimester |
| | O45.022 | Premature separation of placenta with disseminated intravascular coagulation, second trimester |
| | O45.023 | Premature separation of placenta with disseminated intravascular coagulation, third trimester |
| | O45.029 | Premature separation of placenta with disseminated intravascular coagulation, unspecified trimester |
| | O45.091 | Premature separation of placenta with other coagulation defect, first trimester |
| | O45.092 | Premature separation of placenta with other coagulation defect, second trimester |
| | O45.093 | Premature separation of placenta with other coagulation defect, third trimester |
| | O45.099 | Premature separation of placenta with other coagulation defect, unspecified trimester |
| | O45.8X1 | Other premature separation of placenta, first trimester |
| | O45.8X2 | Other premature separation of placenta, second trimester |
| | O45.8X3 | Other premature separation of placenta, third trimester |
| | O45.8X9 | Other premature separation of placenta, unspecified trimester |
| | O45.90 | Premature separation of placenta, unspecified, unspecified trimester |
| | O45.91 | Premature separation of placenta, unspecified, first trimester |
| | O45.92 | Premature separation of placenta, unspecified, second trimester |
| | O45.93 | Premature separation of placenta, unspecified, third trimester |
| | O46.001 | Antepartum hemorrhage with coagulation defect, unspecified, first trimester |
| | O46.002 | Antepartum hemorrhage with coagulation defect, unspecified, second trimester |
| | O46.003 | Antepartum hemorrhage with coagulation defect, unspecified, third trimester |
| | O46.009 | Antepartum hemorrhage with coagulation defect, unspecified, unspecified trimester |
| | O46.011 | Antepartum hemorrhage with afibrinogenemia, first trimester |
| | O46.012 | Antepartum hemorrhage with afibrinogenemia, second trimester |
| | O46.013 | Antepartum hemorrhage with afibrinogenemia, third trimester |
| | O46.019 | Antepartum hemorrhage with afibrinogenemia, unspecified trimester |
| | O46.021 | Antepartum hemorrhage with disseminated intravascular coagulation, first trimester |
| | O46.022 | Antepartum hemorrhage with disseminated intravascular coagulation, second trimester |
| | O46.023 | Antepartum hemorrhage with disseminated intravascular coagulation, third trimester |
| | O46.029 | Antepartum hemorrhage with disseminated intravascular coagulation, unspecified trimester |
| | O46.091 | Antepartum hemorrhage with other coagulation defect, first trimester |
| | O46.092 | Antepartum hemorrhage with other coagulation defect, second trimester |
| | O46.093 | Antepartum hemorrhage with other coagulation defect, third trimester |
| | O46.099 | Antepartum hemorrhage with other coagulation defect, unspecified trimester |
| | O46.8X1 | Other antepartum hemorrhage, first trimester |
| | O46.8X2 | Other antepartum hemorrhage, second trimester |
| | O46.8X3 | Other antepartum hemorrhage, third trimester |
| | O46.8X9 | Other antepartum hemorrhage, unspecified trimester |
| | O46.90 | Antepartum hemorrhage, unspecified, unspecified trimester |
| | O46.91 | Antepartum hemorrhage, unspecified, first trimester |
| | O46.92 | Antepartum hemorrhage, unspecified, second trimester |
| | O46.93 | Antepartum hemorrhage, unspecified, third trimester |
| | O67.0 | Intrapartum hemorrhage with coagulation defect |
| | O67.8 | Other intrapartum hemorrhage |
| | O67.9 | Intrapartum hemorrhage, unspecified |
| | O99.280 | Endocrine, nutritional and metabolic diseases complicating pregnancy, unspecified trimester |
| | O99.281 | Endocrine, nutritional and metabolic diseases complicating pregnancy, first trimester |
| | O99.282 | Endocrine, nutritional and metabolic diseases complicating pregnancy, second trimester |
| | O99.283 | Endocrine, nutritional and metabolic diseases complicating pregnancy, third trimester |
| | O99.411 | Diseases of the circulatory system complicating pregnancy, first trimester |
| | O99.412 | Diseases of the circulatory system complicating pregnancy, second trimester |
| | O99.413 | Diseases of the circulatory system complicating pregnancy, third trimester |
| | O99.419 | Diseases of the circulatory system complicating pregnancy, unspecified trimester |
| | O99.810 | Abnormal glucose complicating pregnancy |
| | P55.0 | Rh isoimmunization of newborn |
| | P55.1 | ABO isoimmunization of newborn |
| | P55.8 | Other hemolytic diseases of newborn |
| | P55.9 | Hemolytic disease of newborn, unspecified |
| | P56.0 | Hydrops fetalis due to isoimmunization |
| | P56.90 | Hydrops fetalis due to unspecified hemolytic disease |
| | P56.99 | Hydrops fetalis due to other hemolytic disease |
| | P83.2 | Hydrops fetalis not due to hemolytic disease |
N/A
| Date | Action | Description |
| 06/16/22 | New medical policy format. | No changes. |
| 05/10/16 | | |
| 09/30/13 | | |
| 03/27/12 | | |
| 12/29/10 | | |
| 04/22/09 | iCES | |
| 05/30/07 | | |
| 02/16/05 | | |
| 02/14/97 | Created | New policy |