d. Categories 647 and 648 are combination codes for nonobstetrical conditions in
obstetrical patients. These conditions are classified elsewhere but will be recorded as
complication of pregnancy, childbirth, or the puerperium. When these codes are used,
an additional code is required to denote the specific condition. With one exception,
code 648.8 does not require an additional code. The code from categories 647 or 648
will take precedence in sequencing.
e. Categories V22 (Normal Pregnancy) and V23 (Supervision of High Risk
Pregnancy) will be used most often for outpatient care. Codes in V22, Normal
pregnancy, are not to accompany any codes in Chapter 11, Complications of
Pregnancy, Childbirth, and the Puerperium. The use of V22.2, Pregnant state
incidental, is used for a patient whose principal diagnosis is unrelated to and is not
complicating the pregnancy. V23 subcategory codes will be used primarily for
outpatient care to identify patients whose pregnancy is of a high risk status; for
example, teenage pregnancies and pregnancies in women over 40 years old are
considered to be high risk in nature and often require close monitoring, even on an
inpatient basis.
APPLICATION
Pregnancy and Puerperium Codes
1. Use an additional code with categories 647 and 648 to further describe the
conditions complicating the pregnancy or the puerperium. Any conditions listed in 647
or 648 categories will require multiple coding, but 647 and 648 codes will be sequenced
prior to the code for the specified condition. (Note exception to dual coding ( para 2d,
above) 648.8 .
EXAMPLE:
DIAGNOSIS: Pregnancy complicated by Sickle-cell
648.23 282.6
Anemia
2. Use fifth digit "4" to identify a postpartum condition or complication following delivery
that occurred during previous episode of care or outside hospital with subsequent
admission.
EXAMPLE:
DIAGNOSIS: Purulent Mastitis, 3 weeks
675.14
following delivery
3. Use V22.2 (Pregnant state, incidental) when patient's cause of admission is not the
pregnancy.
EXAMPLE:
DIAGNOSIS: Meniere's Syndrome, Pregnancy, 16 weeks
386. V22.2
MD0753
A-32