Table 4.
International Classification of Disease and Diagnosis Related Group payment codes used to identify maternal health conditions
| Condition | ICD-9/ DRG code | Definition |
|---|---|---|
| Medical factors | ||
| Maternal medical complication | ||
| Hypertension (including preeclampsia and eclampsia) | 401.XX | Essential hypertension |
| 402.XX | Hypertensive heart disease | |
| 403.XX | Hypertensive kidney disease | |
| 404.XX | Hypertensive heart and kidney disease | |
| 405.XX | Secondary hypertension | |
| 642.XX | Hypertension complicating pregnancy childbirth and the puerperium | |
| Gestational diabetes | 648.00 | Diabetes mellitus complicating pregnancy childbirth or the puerperium |
| 648.01 | Diabetes mellitus of mother with delivery | |
| 648.02 | Diabetes mellitus of mother with delivery with postpartum complication | |
| 648.03 | Antepartum diabetes mellitus | |
| 648.04 | Postpartum diabetes mellitus | |
| 648.8 | Abnormal glucose tolerance of mother complicating pregnancy childbirth or the puerperium | |
| 648.80 | Abnormal glucose tolerance of mother complicating pregnancy childbirth or the puerperium unspecified as to episode of care | |
| 648.81 | Abnormal glucose tolerance of mother with delivery | |
| 648.82 | Abnormal glucose tolerance of mother with delivery with postpartum complication | |
| 648.83 | Abnormal glucose tolerance of mother antepartum | |
| 648.84 | Abnormal glucose tolerance of mother postpartum | |
| Pre-existing diabetes | 250.XX | Diabetes mellitus |
| Obesity | 649.1X | Obesity complicating pregnancy, childbirth, or the puerperium |
| 649.2X | Bariatric surgery status complicating pregnancy, childbirth, or the puerperium | |
| 278.XX | Overweight, obesity and other hyperalimentation | |
| V85.3X | Adult body mass index ≥30.0 and ≤40.9 | |
| V85.4X | Adult body mass index ≥40.0 | |
| Anemia | 280 | Iron deficiency anemia |
| 281 | Nutritional deficiency anemia | |
| 285.2 | Anemia in chronic disease and neoplastic disease | |
| 285.9 | Anemia unspecified | |
| 648.2X | Anemia of mother | |
| Cholestasis | 646.7X | Liver and biliary tract disorders in pregnancy, antepartum condition or complication |
| Periodontal disease | 523.XX | Gingival and periodontal diseases |
| IVF | V2385 | Pregnancy resulting from assisted reproductive technology |
| Infection | ||
| Bacteriuria | 646.5X | Asymptomatic bacteriuria in pregnancy |
| 791.9 | Bacteriuria | |
| Systemic infection | 486 | Pneumonia organism unspecified |
| 540.X | Acute appendicitis | |
| 590.XX | Pyelonephritis or infection of kidney unspecified | |
| Other infections including genital tract infections and STIs | 041.0X | Streptococcus infection |
| 041.5 | Hemophilus influenzae (H. influenzae) infection in conditions classified elsewhere and of unspecified site | |
| 041.8X | Other specified bacterial infections | |
| 042.XX | Human immunodeficiency virus (HIV) | |
| 052.XX | Chickenpox | |
| 053.XX | Herpes zoster | |
| 054.XX | Herpes simplex | |
| 056.XX | Rubella | |
| 070 | Viral hepatitis | |
| 070.0 | Viral hepatitis a with hepatic coma | |
| 070.1 | Viral hepatitis a without hepatic coma | |
| 070.2 | Viral hepatitis b with hepatic coma | |
| 070.20 | Viral hepatitis b with hepatic coma acute or unspecified without hepatitis delta | |
| 070.21 | Viral hepatitis b with hepatic coma acute or unspecified with hepatitis delta | |
| 070.3 | Viral hepatitis b without mention of hepatic coma | |
| 070.30 | Viral hepatitis b without hepatic coma acute or unspecified without hepatitis delta | |
| 070.31 | Viral hepatitis b without hepatic coma acute or unspecified with hepatitis delta | |
| 075.XX | Infectious mononucleosis | |
| 078.5 | Cytomegaloviral disease | |
| 079.53 | Human immunodeficiency virus type 2 [HIV-2] | |
| 079.83 | Parvovirus b19 | |
| 090.XX | Congenital syphilis | |
| 091.XX | Syphilis | |
| 092.XX | Early syphilis, latent | |
| 093.XX | Cardiovascular syphilis | |
| 094.XX | Neurosyphilis | |
| 095.XX | Other forms of syphilis with symptoms | |
| 096.XX | Late syphilis, latent | |
| 097.XX | Other and unspecified late syphilis | |
| 098.XX | Gonococcal infection | |
| 099.XX | Venereal disease due to chlamydia | |
| 130.XX | Toxoplasmosis | |
| 131.XX | Trichomoniasis | |
| 599.0 | Urinary tract infection site not specified | |
| 616.1X | Bacterial vaginosis | |
| 646.6X | Infections of genitourinary tract | |
| 647.60 | Other viral diseases of mother complicating pregnancy childbirth or the puerperium unspecified as to episode of care | |
| 647.61 | Other viral diseases of mother with delivery | |
| 647.62 | Other viral diseases of mother with delivery with postpartum complication | |
| 647.63 | Other antepartum viral diseases | |
| 647.64 | Other postpartum viral diseases | |
| 771.1 | Congenital cytomegalovirus infection | |
| 795.71 | Nonspecific serologic evidence of human immunodeficiency virus (HIV) | |
| V08 | Asymptomatic human immunodeficiency virus (HIV) infection status | |
| Prior obstetric history | ||
| Cervical incompetence | 654.5x | Cervical incompetence |
| Previous preterm labor | V23.41 | Pregnancy with history of pre-term labor |
| Poor obstetric history | V23.49 V23.5 | Pregnancy with other poor obstetric history Supervision of high-risk pregnancy with other poor obstetric history |
| Obstetric complication | ||
| Hemorrhage | 656.00 | Fetal-maternal hemorrhage unspecified as to episode of care in pregnancy |
| 656.01 | Fetal-maternal hemorrhage with delivery | |
| 656.03 | Fetal-maternal hemorrhage antepartum condition or complication | |
| Premature rupture of membranes | 658.1X | Premature rupture of membranes |
| 658.20 | Delayed delivery after spontaneous or unspecified rupture of membranes unspecified as to episode of care | |
| 658.21 | Delayed delivery after spontaneous or unspecified rupture of membranes delivered | |
| 658.23 | Delayed delivery after spontaneous or unspecified rupture of membranes antepartum | |
| Fetal complication | ||
| Polyhydramnios | 657.XX | Polyhydramnios |
| Fetal growth | 656.50 | Poor fetal growth affecting management of mother unspecified as to episode of care |
| 656.51 | Poor fetal growth affecting management of mother delivered | |
| 656.53 | Poor fetal growth affecting management of mother and antepartum condition or complication | |
| Mode of delivery | ||
| Cesarean section | DRG765 | Cesarean section w cc/mc |
| DRG766 | Cesarean section w/o cc/mc | |
| Vaginal | DRG774 | Vaginal delivery w complicating diagnoses |
| DRG775 | Vaginal delivery w/o complicating diagnoses | |
| Behavioural factors | ||
| Substance use (drugs, alcohol, and tobacco) | 303.XX | Acute alcoholic intoxication or other and unspecified alcohol dependence |
| 304.XX | Drug dependence | |
| 305.XX | Nondependent abuse of drugs | |
| 648.33 | Antepartum drug dependence | |
| 649.0X | Tobacco use disorder complicating pregnancy, childbirth, or the puerperium | |
| Psychosocial factors | ||
| Mental health condition | 290.1X | Presenile dementia |
| 290.4X | Vascular dementia | |
| 291.XX | Alcohol withdrawal and alcohol-induced mental disorders | |
| 292.XX | Drug withdrawal and drug-induced mental disorders | |
| 293.XX | Delirium and psychotic, mood, anxiety and transient mental disorders | |
| 294.XX | Amnestic disorder, dementia, and other persistent mental disorders | |
| 295.XX | Schizophrenia | |
| 296.XX | Bipolar, manic affective, major depressive and episodic mood disorders | |
| 297.X | Paranoid state, delusional, paraphrenia and shared psychotic disorders | |
| 298.X | Depressive type psychosis, excitative type psychosis, reactive confusion, acute paranoid reaction, psychogenic paranoid psychosis, other and unspecified reactive psychosis and unspecified psychosis | |
| 299.XX | Autistic disorder, childhood disintegrative disorder, other or unspecified pervasive developmental disorder | |
| 300.XX | Anxiety state unspecified, panic disorder without agoraphobia, generalized anxiety disorder, other anxiety states, hysteria unspecified, conversion disorder, dissociative amnesia, dissociative fugue, dissociative identity disorder, dissociative disorder or reaction unspecified, factitious disorder with predominantly psychological signs and symptoms, other and unspecified factitious illness, phobia unspecified, agoraphobia with panic disorder, agoraphobia without panic attacks, social phobia, other isolated or specific phobias, obsessive-compulsive disorders, dysthymic disorder, neurasthenia, depersonalization disorder, hypochondriasis, somatization disorder, undifferentiated somatoform disorder, other somatoform disorders, unspecified nonpsychotic mental disorder | |
| 301.XX | Paranoid personality disorder, affective personality disorder unspecified, chronic hypomanic personality disorder, chronic depressive personality disorder, cyclothymic disorder, schizoid personality disorder unspecified, introverted personality, schizotypal personality disorder, explosive personality disorder, obsessive-compulsive personality disorder, histrionic personality disorder unspecified, chronic factitious illness with physical symptoms, other histrionic personality disorder, dependent personality disorder, antisocial personality disorder, narcissistic personality disorder, avoidant personality disorder, borderline personality disorder, passive-aggressive personality, other personality disorders, unspecified personality disorder | |
| 302.XX | Unspecified psychosexual disorder | |
| 317 | Mild intellectual disabilities | |
| 318.X | Moderate, severe and profound intellectual disabilities | |
| 319 | Unspecified intellectual disabilities | |
| 648.4X | Mental disorders of mother | |
DRG Diagnosis Related Group, HIV human immunodeficiency virus, ICD-9 International Classification of Diseases, Ninth Revision, IVF in vitro fertilization, STI sexually transmitted infection