Medical terminology of a fetus not carried to full term.
Today I am going to talk about what seems to be a very politically charged topic at the moment, but I am not actually going there. I want to review the term “abortion,” in medical terminology, and discuss procedures relating to a fetus not carried to full term.
People generally do not read the textbook. Although ovulation is usually asserted to occur around 14 days prior to onset of menses, with a fertility period of approximately six days preceding and including the day of ovulation, in reality, the time during which a woman can conceive is rather variable, and often unpredictable. Adolescent and perimenopausal individuals, and women with irregular menses, have even less reliable timing.
Fertilization of the egg by the sperm occurs in the fallopian tube during that fertile period, and under normal circumstances, the fertilized egg travels down until it reaches the uterus, and the 70 to 100 cell blastocyst then implants against the uterine wall. There are differing opinions as to whether conception is considered the moment of fertilization or implantation. However, unless implantation occurs (in a normal uterine location), there is no chance of a pregnancy that will result in delivery of a baby. The fertilized yet-not-implanted egg gets expelled during menstruation.
The word “embryo” refers to the period from time of implantation to the end of the eighth week after conception. From the beginning of the ninth week on, it is called a “fetus.” At the moment of delivery, the term is “neonate,” newborn infant, or baby. Fetuses are not viable prior to 22 weeks of gestation, and likelihood of survival increases to between 60 and 70 percent at 24 weeks gestation. About 40 percent of premature infants at this age will suffer long-term health complications.
An ectopic pregnancy is when a fertilized egg grows outside of the main cavity of the uterus. More than 90 percent of these occur in a fallopian tube at high risk for rupture. Other locations include ovarian, in an abnormal area in the uterus (like cornual, cervical, or in a cesarean scar), or abdominal. Ectopic pregnancies can be further complicated by occurring in concert with an intrauterine pregnancy, often because they are more common in cases of infertility treatment. “Uncomplicated” ectopic pregnancy ICD-10-CM codes are found in O00.-, and codes for ectopic and molar pregnancies with complications are housed in O08.-.
Fetal survival of an ectopic pregnancy is exceedingly rare, and there is a grave threat to the mother’s life if it is not terminated in a timely fashion. The only treatment for an ectopic pregnancy is ending the pregnancy, and it often requires surgical intervention, which results in excision/resection of the affected body part.
The medical definition of abortion is “the termination of a pregnancy after, accompanied by, resulting in, or closely followed by the death of the embryo or fetus.” Secondary definitions are “spontaneous expulsion of a human fetus during the first 12 weeks of gestation” and “induced expulsion of a human fetus.”
In other words, a miscarriage, in medical terms, is called a spontaneous abortion. The most common causes of miscarriage are genetic or chromosomal abnormalities, placental issues, medical or anatomical conditions involving the mother, and infection. Spontaneous abortions most commonly occur so early in the pregnancy (weeks 0-6) that the patient may not even be aware they are pregnant, and may think it is just a late period. An estimated 10-15 percent of known pregnancies end in miscarriage.
If the embryo or fetus dies and the body naturally expels all the products of conception, it is termed “complete abortion.” If some of the products pass, but some parts of the fetus, placenta, or membranes are retained, it is called an “incomplete abortion.” An “inevitable abortion” is the scenario when the cervix has dilated in preparation for expulsion, but has not yet done so. For some coding reason unfathomable to me as a clinician, inevitable abortion indexes to O03.4, Incomplete spontaneous abortion without complication.
A “missed abortion” (O02.1) is when a fetus has died (not proximately, usually days to weeks ago), but the body does not proceed to expel the nonviable intrauterine pregnancy. A “septic abortion” is a result of intrauterine infection following an abortion. Finally, a “threatened abortion” (O20.0) is vaginal bleeding in pregnancy before 20 weeks with a closed cervix (i.e., not an inevitable abortion). A total of 25 percent of pregnancies have some bleeding in early pregnancy, and approximately half of these progress to abortion.
There are other complications of pregnancy that can result in the need for removal of nonviable products of conception. These include a blighted ovum (O02.0), in which an early embryo never develops or arrests, and a hydatidiform mole (AKA molar pregnancy, O01.-), when a noncancerous tumor forms instead of a healthy placenta. Complete and incomplete spontaneous abortions and their complications, such as pelvic infection, hemorrhage, sepsis, and shock, are coded in O03.-.
These spontaneous pregnancy losses are distinct from elective termination of pregnancy. In ICD-10-CM, there is a distinction between an encounter for elective termination of pregnancy without complications (Z33.2) and conditions/complications following induced (O04.-) or failed attempted termination (O07.-) of pregnancy.
Inducing abortion can either be accomplished by procedural or medical means. For outpatient procedures, Current Procedural Terminology (CPT) codes are utilized. The American College of Obstetrics and Gynecology (ACOG) recommends that abortions after 20 weeks be reported using a delivery code. However, they stipulate that some state legislatures legally define the distinction between a miscarriage and a stillbirth by the number of weeks or by weight, and this may guide the choice of CPT code.
If a patient is admitted in the hospital, then ICD-10-PCS codes are used. The body part for the obstetrics section is always some version of products of conception (POC, retained products, or ectopic).
I hope this sheds light on the definitions, ICD-10-CM diagnoses, and procedure coding of miscarriage and abortion. It’s the best I can do.
Resources:
EDITOR’S NOTE: With Halloween on the radar, ICD10monitor Contributor Christine Geiger, Assistant Vice President of Acute and Post-Acute Coding Services for the St. Louis-based First
Wrapping up our discussion of the ICD-10-CM and PCS code updates released on Oct. 1, in this article we will examine some PCS-related changes. I
Please log in to your account to comment on this article.
Optimize your outpatient clinical documentation and gain comprehensive knowledge from foundational practices to advanced technologies, ensuring improved patient care and organizational and financial success. This webcast bundle provides a holistic approach to outpatient CDI, empowering you to implement best practices from the ground up and leverage advanced strategies for superior results. You will gain actionable insights to improve documentation quality, patient care, compliance, and financial outcomes.
Enhancing outpatient clinical documentation is crucial for maintaining accuracy, compliance, and proper reimbursement in today’s complex healthcare environment. This webcast, presented by industry expert Angela Comfort, DBA, RHIA, CDIP, CCS, CCS-P, will provide you with actionable strategies to tackle complex challenges in outpatient documentation. You’ll learn how to craft detailed clinical narratives, utilize advanced EHR features, and implement accurate risk adjustment and HCC coding. The session also covers essential regulatory updates to keep your documentation practices compliant. Join us to gain the tools you need to improve documentation quality, support better patient care, and ensure financial integrity.
This webcast, presented by Angela Comfort, DBA, RHIA, CDIP, CCS, CCS-P, a recognized expert with over 30 years of experience, offers essential strategies to improve outpatient clinical documentation integrity. You will learn how to enhance the accuracy and completeness of patient records by adopting best practices in coding and incorporating Social Determinants of Health (SDOH). The session also highlights the role of technology, such as EHRs and CDI software, in improving documentation quality. By attending, you will gain practical insights into ensuring precise and compliant documentation, supporting patient care, and optimizing reimbursement. This webcast is crucial for those looking to address documentation gaps and elevate their coding practices.
ICD10monitor has teamed up with renowned CDI expert Dr. Erica Remer to bring you an exclusive webcast on how to recognize sepsis, how to get providers to give documentation that will support sepsis, and how to educate to avert sepsis denials. Register now and become a crucial piece of the solution to standardizing sepsis clinical practice, documentation, and coding at your facility.
Protect your facility from unwanted audits! Join Becky Jacobsen, BSN, RN, MBS, CCS-P, CPC, CPEDC, CBCS, CEMC, and take a deep dive into both the CMS and AMA guidelines for reporting post operative pain blocks. You’ll learn how to determine if the nerve block is separately codable with real life examples for better understanding. Becky will also cover how to evaluate whether documentation supports medical necessity, offer recommendations for stronger documentation practices, and provide guidance on educating providers about documentation requirements. She’ll include a discussion of appropriate modifier and diagnosis coding assignment so that you can be confident that your billing of post operative pain blocks is fully supported and compliant.
During this RACmonitor webcast Dr. Ronald Hirsch spotlights the areas of the OIG’s Work Plan and the findings of their most recent audits that impact utilization review, case management, and audit staff. He also provides his common-sense interpretation of the prevailing regulations related to those target issues. You’ll walk away better equipped with strategies to put in place immediately to reduce your risk of paybacks, increased scrutiny, and criminal penalties.
This webcast, presented by Tiffany Ferguson, LMSW, CMAC, ACM, addresses the critical gap in Social Determinants of Health (SDoH) reporting for pediatric populations. While SDoH efforts often focus on adults, this session emphasizes the unique needs of children. Attendees will gain insights into the current state of SDoH, new pediatric Z-codes, and the importance of interdisciplinary collaboration. By understanding and applying pediatric-specific SDoH factors, healthcare professionals can improve data capture, compliance, and care outcomes. This webcast is essential for those looking to enhance their approach to pediatric SDoH reporting and coding.
Join Becky Jacobsen, BSN, RN, MBS, CCS-P, CPC, CPEDC, CBCS, CEMC, VP of CDM, for a webcast addressing oncology service coding challenges. Learn to navigate coding for infusions and injections alongside Evaluation and Management (E/M) services, ensuring compliance and accurate reimbursement. Gain insights into documenting E/M services for oncology patients and determining medical necessity. This webcast is essential to optimize coding practices, maintain compliance, and maximize revenue in oncology care.
Copyright © 2024 ICD10monitor. Powered by MedLearn Media.
Prepare for the 2025 CMS IPPS Final Rule with ICD10monitor’s IPPSPalooza! Click HERE to learn more
Get 15% OFF on all educational webcasts at ICD10monitor with code JULYFOURTH24 until July 4, 2024—start learning today!
đź‘»Spooky Sale is Back!đź‘» Get 31% off all three Medlearn brands, using code SPOOKY24.
