2025 ICD-10-CM code O09
(Active) Effective Date: N/A Revision Date: N/A Deletion Date: N/A Pregnancy, childbirth and the puerperium - Supervision of high-risk pregnancy 15: Pregnancy, Childbirth and the Puerperium Feed
Supervision of a high-risk pregnancy.
Modifiers may be applicable depending on the circumstances of the visit, such as the place of service or the type of visit.Consult the appropriate coding guidelines.
Medical necessity for code O09 is established by the presence of risk factors that increase the likelihood of complications during pregnancy.The frequency and intensity of visits are determined by the specific risks and needs of the patient.
The clinical responsibility involves the comprehensive management of the high-risk pregnancy, including regular prenatal visits, monitoring of the mother's and fetus's health, screening for potential complications, and management of any identified problems. This may also include coordinating care with specialists as needed.
In simple words: This code is used when a doctor is monitoring a pregnancy that is considered high-risk because of certain factors, like previous problems with getting pregnant, previous ectopic pregnancies, previous molar pregnancies, a history of difficult pregnancies or deliveries, lack of prenatal care, or the mother's age or social situation. The code is only used during the pregnancy itself, before the baby is born.Other codes may be needed to describe specific problems.
This code is used to report the supervision of a pregnancy considered high-risk due to various factors such as a history of infertility, ectopic pregnancy, molar pregnancy, poor reproductive or obstetric history, insufficient antenatal care, grand multiparity, maternal age (elderly primigravida or multigravida, or young primigravida or multigravida), social problems, or other specified high-risk conditions.It is intended for use only during the prenatal period.Additional codes may be necessary to specify the trimester and any specific complications.
Example 1: A 38-year-old woman with a history of infertility is undergoing in-vitro fertilization (IVF) and conceives.The pregnancy is considered high-risk due to her age and the use of assisted reproductive technology.Code O09 would be used for prenatal visits to monitor her pregnancy., A 25-year-old woman with a prior ectopic pregnancy is pregnant again.Her pregnancy is classified as high-risk because of the history of ectopic pregnancy. Code O09 would be used for monitoring this high-risk pregnancy, along with possible additional codes to further specify the type of high-risk pregnancy., A 16-year-old pregnant teenager with poor prenatal care presents for a routine visit. Her pregnancy is high risk due to her young age and lack of adequate prenatal care. Code O09 along with potentially additional codes for the risk factors would be used for billing purposes.
Detailed medical history including prior pregnancies, obstetrical history, current medical conditions, relevant social history, results of all prenatal tests, and notes on the clinical management of the pregnancy.Documentation must support the reason for considering the pregnancy high-risk.
** This code should be the principal diagnosis for routine prenatal outpatient visits for high-risk pregnancies.It is crucial to accurately document the reasons for classifying the pregnancy as high-risk.Remember that this code is only used during the prenatal period. After delivery, different codes are used to report complications related to the pregnancy or delivery.
- Revenue Code: This will vary depending on the payer and the specific services provided.Consult your payer's guidelines.
- RVU: RVUs vary based on location, facility type, and other factors.Consult your local fee schedule.
- Global Days: Not applicable.
- Payment Status: Active
- Modifier TC rule: Not applicable.
- Fee Schedule: Historical fee schedules are not provided here. Consult your local fee schedule for historical data.
- Specialties:Obstetrics and Gynecology
- Place of Service:Office, Outpatient Hospital, Ambulatory Surgical Center