ICD-10 Coding for Preterm Premature Rupture of Membranes(O42.11)
Complete ICD-10-CM coding and documentation guide for Preterm Premature Rupture of Membranes. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to Preterm Premature Rupture of Membranes
O42.0-O42.9Primary Range
Premature rupture of membranes
This range includes codes for premature rupture of membranes, specifying gestational age and time between rupture and labor.
Key Information: ICD-10 code for PPROM
Essential facts and insights about Preterm Premature Rupture of Membranes
Primary ICD-10-CM Code for pprom
Decision Criteria
clinical Criteria
- Gestational age <37 weeks and labor onset >24 hours after rupture
Applicable To
- PPROM with labor onset >24h in third trimester
Excludes
- Full-term PROM (O42.12)
Clinical Validation Requirements
- Gestational age <37 weeks
- Labor onset >24 hours after rupture
Code-Specific Risks
- Incorrectly coding as full-term PROM
Coding Notes
- Ensure documentation specifies gestational age and time between rupture and labor onset.
Ancillary Codes
Additional codes that should be used in conjunction with the main diagnosis codes when applicable.
Chorioamnionitis, third trimester
O41.1213Documentation & Coding Risks
Avoid these common documentation and coding issues when documenting Preterm Premature Rupture of Membranes to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code O42.11.
Impact
Clinical: Inaccurate clinical picture, Regulatory: Potential audit failure, Financial: Incorrect reimbursement
Mitigation Strategy
Always include gestational age in documentation, Use templates to ensure completeness
Impact
Reimbursement: May lead to incorrect DRG assignment., Compliance: Non-compliance with coding guidelines., Data Quality: Inaccurate clinical data representation.
Mitigation Strategy
Query for exact timing if missing and use specific code.
Impact
Missing gestational age can lead to incorrect coding.
Mitigation Strategy
Implement mandatory fields in EHR for gestational age.
Documentation errors, coding pitfalls, and audit risks are interconnected aspects of medical coding and billing. Addressing all three areas helps ensure accurate coding, optimal reimbursement, and regulatory compliance.
Frequently Asked Questions
Common questions about ICD-10 coding for Preterm Premature Rupture of Membranes, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Preterm Premature Rupture of Membranes
Use these documentation templates to ensure complete and accurate documentation for Preterm Premature Rupture of Membranes. These templates include all required elements for proper coding and billing.
Uncomplicated PPROM
Specialty: ObstetricsRequired Elements
- Gestational age
- Confirmation of rupture
- Rupture timing
- Labor onset
- Infection markers
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
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