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Table 4 International Classification of Disease and Diagnosis Related Group payment codes used to identify maternal health conditions

From: Area-level deprivation and preterm birth: results from a national, commercially-insured population

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

  1. DRG Diagnosis Related Group, HIV human immunodeficiency virus, ICD-9 International Classification of Diseases, Ninth Revision, IVF in vitro fertilization, STI sexually transmitted infection