ICD-10 Diagnosis Codes that identify weeks gestation of pregnancy and birth weight requirement when billing a delivery CPT Procedure Code
Effective for Dates of Service beginning January 1, 2017, and thereafter, Medicaid required a Weeks Gestation of Pregnancy Diagnosis Code and a birth weight on delivery claims billed on an UB-04 or CMS 1500 Claim Form if a recipient has received any prenatal, delivery or postpartum services.
If delivery or prenatal visit CPT Procedure Codes are billed on an UB-04 or CMS 1500 Claim Form, an ICD-10 Diagnosis Code must be appended to identify the weeks gestation of pregnancy. The weeks gestation of pregnancy IS required on the mother’s claim, NOT the newborn’s claim.
The Weeks Gestation of Pregnancy Diagnosis Code and CPT Procedure Code for deliveries and prenatal visits must be linked by a Diagnosis Pointer/Indicator referenced on the claim detail. This means that the claim detail with the CPT Procedure Code for a delivery must have a Diagnosis Pointer referencing the Weeks Gestation of Pregnancy Diagnosis Code.
Claims that Require Gestational Age Diagnosis Codes
If any of the following claim types are billed, a Weeks Gestation of Pregnancy Diagnosis Code must be appended to the claim. The Weeks Gestation of Pregnancy Diagnosis Codes are Z3A.00 through Z3A49 and are listed below in Table 1.0.
1. A CMS 1500 or UB-04 claim (Professional and Outpatient Hospital claims) using the following delivery codes:
59400-59410 Vaginal delivery
59510-59515 Cesarean delivery
59610-59622 Delivery after previous cesarean delivery
2. A Nurse Midwife or Physician with specialties 316 (Family Practitioner), 318 (General Practitioner), 328 (OB-GYN) billing Office Visits Codes and Professional claims using a CMS 1500 Claim Form.
Z33 Pregnant state
Z34 Encounter for supervision of normal pregnancy
Z32.01 Encounter for pregnancy test-positive
O00-O08 Pregnancy with abortive outcome
O09-O09 Supervision of high risk pregnancy
O20-O29 Other maternal disorders predominantly related to pregnancy
O30-O48 Maternal care related to the fetus and amniotic cavity and possible delivery problems
99201-99205 New Patent Office Visits
99211-99215 Established Patient Office Visits
3. An Institutional Inpatient UB-04 Claim Forms using any of the following ICD-10 Procedure Codes:
10D00Z0-10D0728 Cesarean Delivery
10E0XZZ Vaginal Delivery
Birth Weight Requirement on Institutional Inpatient UB-04 Claim Forms
An Institutional Inpatient UB-04 delivery claim requires a birthweight when an ICD-10 Surgical Procedure Code or an ICD-10 Diagnosis Code indicating delivery is submitted. *This birthweight requirement only applies to deliveries with a gestational age of 20 weeks or greater (Z3A.20 – Z3A.49). If a delivery claim is indicated as resulting in twins or triplets, a birthweight must be submitted for each newborn using the same criteria for a single newborn. This policy also applies to sick and well babies.
Please follow these guidelines for inpatient delivery claims
• For paper claims, enter value code 54 in box 39, 40 or 41 and the newborn’s birth weight (in grams) in the corresponding amount field.
• For electronic claims, enter the newborn’s birth weight in loop 2300, segment HI, with the qualifier BE and the value code 54 in HI01-2 and the newborn’s weight (in grams) in HI01-5.
• Newborn birth weight must be entered in the format of xxxx.xx.
The claim form must contain one of the following ICD-10 Surgical Procedure Code;
10D00Z0-10D07Z8 Cesarean Delivery
10E0XZZ Vaginal Delivery
One of the following ICD-10 Diagnosis Codes;
O68-O709 Deliveries with Complication
O80-O82 Encounter for Delivery
One of the following Weeks Gestation of Pregnancy Diagnosis Codes listed in Table 1.0.
Z3A20 20 WEEKS GESTATION OF PREGNANCY Z3A32 32 WEEKS GESTATION OF PREGNANCY
Z3A21 21 WEEKS GESTATION OF PREGNANCY Z3A33 33 WEEKS GESTATION OF PREGNANCY
Z3A22 22 WEEKS GESTATION OF PREGNANCY Z3A34 34 WEEKS GESTATION OF PREGNANCY
Z3A23 23 WEEKS GESTATION OF PREGNANCY Z3A35 35 WEEKS GESTATION OF PREGNANCY
Z3A24 24 WEEKS GESTATION OF PREGNANCY Z3A36 36 WEEKS GESTATION OF PREGNANCY
Z3A25 25 WEEKS GESTATION OF PREGNANCY Z3A37 37 WEEKS GESTATION OF PREGNANCY
Z3A26 26 WEEKS GESTATION OF PREGNANCY Z3A38 38 WEEKS GESTATION OF PREGNANCY
Z3A27 27 WEEKS GESTATION OF PREGNANCY Z3A39 39 WEEKS GESTATION OF PREGNANCY
Z3A28 28 WEEKS GESTATION OF PREGNANCY Z3A40 40 WEEKS GESTATION OF PREGNANCY
Z3A29 29 WEEKS GESTATION OF PREGNANCY Z3A41 41 WEEKS GESTATION OF PREGNANCY
Z3A30 30 WEEKS GESTATION OF PREGNANCY Z3A42 42 WEEKS GESTATION OF PREGNANCY
Z3A31 31 WEEKS GESTATION OF PREGNANCY Z3A49 GREATER THAN 42 WEEKS GESTATION
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