a. A large portion of the military services inpatient workload is comprised of
conditions relating to pregnancy, labor, delivery, and the puerperium. Coding personnel
should be thoroughly familiar with the sections in chapter 11 used in classifying specific
conditions associated with obstetrics ; for example:
(1) Categories 64-648 complications mainly related to pregnancy.
(2) Categories 65-659 normal delivery, and other indications of care in
pregnancy, labor and delivery.
(3) Categories 66-669 complications occurring mainly in the course of labor
(4) Categories 67-676 complications of the puerperium.
b. Category 65 (Delivery in a completely normal case) includes only normal,
spontaneous delivery, cephalic (vertex) presentation, of a single full -term live-born
infant. An episiotomy or amniotomy may be performed. This code excludes application
of forceps or any manipulation to assist delivery. This code excludes stillbirth or
multiple births. This code cannot be used in combination with other codes in chapter
c. In assigning codes from the V27 category in conjunction with the 65 code,
V27. is the only valid outcome of delivery code which can be used.
d. Subcategory 669.5 (Forceps or Ventouse Delivery without mention of indication)
includes normal delivery of a live fetus, cephalic presentation, with application of low or
outlet forceps or vacuum extraction without mention of any complication of labor or
delivery. 669.5 is used with mid or high forceps only if the complication necessitating
the use of mid or high forceps is not stated.
e. Subcategory 656.4 (Intrauterine Death) includes delivery of a fetal death
(stillbirth) after completion of 20 weeks gestation. The key word in the Alphabetic Index
is Intrauterine Death, not stillbirth.
f. Subcategory 644.2 (Early Onset of Delivery) includes premature delivery,
premature labor with onset of delivery and spontaneous delivery of premature infant.
g. Category 651 (Multiple Gestation Delivery). This code is for use in denoting
multiple gestation, either during pregnancy or for delivery.
h. Outcome of Delivery. The V27 category is to be used to record the outcome of
delivery on the mother's cover sheet. In the Alphabetic Index look for "Outcome of
Delivery," which will lead to the V27 category. This V27 category has subcategories to
denote live-born and stillborn.
i. In the case of a stillbirth, the appropriate V27 code will be recorded on the
mother's cover sheet, and there will be no separate record made for the stillbirth.