COMPLICATIONS MAINLY RELATED TO PREGNANCY (640-648)

• Includes: the listed conditions even if they arose or were present during labor, delivery, or the puerperium
• The following fifth-digit subclassification is for use with categories 640-648 to denote the current episode of care:
  • 0 unspecified as to episode of care or not applicable
  • 1 delivered, with or without mention of antepartum condition
    • Antepartum condition with delivery
    • Delivery NOS (with mention of antepartum complication during current episode of care)
    • Intrapartum
      • obstetric condition (with mention of antepartum complication during current episode of care)
    • Pregnancy
      • delivered (with mention of antepartum complication during current episode of care)
  • 2 delivered, with mention of postpartum complication
    • Delivery with mention of puerperal complication during current episode of care
  • 3 antepartum condition or complication
    • Antepartum obstetric condition, not delivered during the current episode of care
  • 4 postpartum condition or complication
    • Postpartum or puerperal obstetric condition or complication following delivery that occurred:
      • during previous episode of care
      • outside hospital, with subsequent admission for observation or care
• 640 Hemorrhage in early pregnancy
  • Requires fifth digit; valid digits are in [brackets] under each code. See beginning of section 640-648 for definitions.
  • Includes: hemorrhage before completion of 22 weeks' gestation
  • 640.0 Threatened abortion
  • [0,1,3]
  • 640.8 Other specified hemorrhage in early pregnancy
  • [0,1,3]
  • 640.9 Unspecified hemorrhage in early pregnancy
  • [0,1,3]
• 641 Antepartum hemorrhage, abruptio placentae, and placenta previa
  • Requires fifth digit; valid digits are in [brackets] under each code. See beginning of section 640-648 for definitions.
  • 641.0 Placenta previa without hemorrhage
  • [0,1,3] Low implantation of placenta without hemorrhage
    • Placenta previa noted:
      • during pregnancy without hemorrhage
      • before labor (and delivered by cesarean delivery) without hemorrhage
  • 641.1 Hemorrhage from placenta previa
  • [0,1,3] Low-lying placenta NOS or with hemorrhage (intrapartum)
    • Placenta previa:
      • incomplete NOS or with hemorrhage (intrapartum)
      • marginal NOS or with hemorrhage (intrapartum)
      • partial NOS or with hemorrhage (intrapartum)
      • total NOS or with hemorrhage (intrapartum)
    • Excludes: hemorrhage from vasa previa (663.5)
  • 641.2 Premature separation of placenta
  • [0,1,3] Ablatio placentae
    • Abruptio placentae
    • Accidental antepartum hemorrhage
    • Couvelaire uterus
    • Detachment of placenta (premature)
    • Premature separation of normally implanted placenta
  • 641.3 Antepartum hemorrhage associated with coagulation defects
  • [0,1,3] Antepartum or intrapartum hemorrhage associated with:
    • afibrinogenemia
    • hyperfibrinolysis
    • hypofibrinogenemia
  • 641.8 Other antepartum hemorrhage
  • [0,1,3] Antepartum or intrapartum hemorrhage associated with:
    • trauma
    • uterine leiomyoma
  • 641.9 Unspecified antepartum hemorrhage
  • [0,1,3] Hemorrhage:
    • antepartum NOS
    • intrapartum NOS
    • of pregnancy NOS
• 642 Hypertension complicating pregnancy, childbirth, and the puerperium
  • Requires fifth digit; valid digits are in [brackets] under each code. See beginning of section 640-648 for definitions.
  • 642.0 Benign essential hypertension complicating pregnancy, childbirth, and the puerperium
  • [0-4] Hypertension:
    • benign essential specified as complicating, or as a reason for obstetric care during pregnancy, childbirth, or the puerperium
    • chronic NOS specified as complicating, or as a reason for obstetric care during pregnancy, childbirth, or the puerperium
    • essential specified as complicating, or as a reason for obstetric care during pregnancy, childbirth, or the puerperium
    • pre-existing NOS specified as complicating, or as a reason for obstetric care during pregnancy, childbirth, or the puerperium
  • 642.1 Hypertension secondary to renal disease, complicating pregnancy, childbirth, and the puerperium
  • [0-4] Hypertension secondary to renal disease, specified as complicating, or as a reason for obstetric care during pregnancy, childbirth, or the puerperium
  • 642.2 Other pre-existing hypertension complicating pregnancy, childbirth, and the puerperium
  • [0-4] Hypertensive:
    • heart and renal disease specified as complicating, or as a reason for obstetric care during pregnancy, childbirth, or the puerperium
    • heart disease specified as complicating, or as a reason for obstetric care during pregnancy, childbirth, or the puerperium
    • renal disease specified as complicating, or as a reason for obstetric care during pregnancy, childbirth, or the puerperium
    • Malignant hypertension specified as complicating, or as a reason for obstetric care during pregnancy, childbirth, or the puerperium
  • 642.3 Transient hypertension of pregnancy
  • [0-4] Gestational hypertension
    • Transient hypertension, so described, in pregnancy, childbirth, or the puerperium
  • 642.4 Mild or unspecified pre-eclampsia
  • [0-4] Hypertension in pregnancy, childbirth, or the puerperium, not specified as pre-existing, with either albuminuria or edema, or both; mild or unspecified
    • Pre-eclampsia:
      • NOS
      • mild
    • Toxemia (pre-eclamptic):
      • NOS
      • mild
    • Excludes: albuminuria in pregnancy, without mention of hypertension (646.2)
      • edema in pregnancy, without mention of hypertension (646.1)
  • 642.5 Severe pre-eclampsia
  • [0-4] Hypertension in pregnancy, childbirth, or the puerperium, not specified as pre-existing, with either albuminuria or edema, or both; specified as severe
    • Pre-eclampsia, severe
    • Toxemia (pre-eclamptic), severe
  • 642.6 Eclampsia
  • [0-4] Toxemia:
    • eclamptic
    • with convulsions
  • 642.7 Pre-eclampsia or eclampsia superimposed on pre-existing hypertension
  • [0-4] Conditions classifiable to 642.4-642.6, with conditions classifiable to 642.0-642.2
  • 642.9 Unspecified hypertension complicating pregnancy, childbirth, or the puerperium
  • [0-4] Hypertension NOS, without mention of albuminuria or edema, complicating pregnancy, childbirth, or the puerperium
• 643 Excessive vomiting in pregnancy
  • Requires fifth digit; valid digits are in [brackets] under each code. See beginning of section 640-648 for definitions.
  • Includes: hyperemesis arising during pregnancy
    • vomiting:
      • persistent arising during pregnancy
      • vicious arising during pregnancy
    • hyperemesis gravidarum
  • 643.0 Mild hyperemesis gravidarum
  • [0,1,3] Hyperemesis gravidarum, mild or unspecified, starting before the end of the 22nd week of gestation
  • 643.1 Hyperemesis gravidarum with metabolic disturbance
  • [0,1,3] Hyperemesis gravidarum, starting before the end of the 22nd week of gestation, with metabolic disturbance, such as:
    • carbohydrate depletion
    • dehydration
    • electrolyte imbalance
  • 643.2 Late vomiting of pregnancy
  • [0,1,3] Excessive vomiting starting after 22 completed weeks of gestation
  • 643.8 Other vomiting complicating pregnancy
  • [0,1,3] Vomiting due to organic disease or other cause, specified as complicating pregnancy, or as a reason for obstetric care during pregnancy
    • Use additional code to specify cause
  • 643.9 Unspecified vomiting of pregnancy
  • [0,1,3] Vomiting as a reason for care during pregnancy, length of gestation unspecified
• 644 Early or threatened labor
  • Requires fifth digit; valid digits are in [brackets] under each code. See beginning of section 640-648 for definitions.
  • 644.0 Threatened premature labor
  • [0,3] Premature labor after 22 weeks, but before 37 completed weeks of gestation without delivery
    • Excludes: that occurring before 22 completed weeks of gestation (640.0)
  • 644.1 Other threatened labor
  • [0,3] False labor:
    • NOS without delivery
    • after 37 completed weeks of gestation without delivery
    • Threatened labor NOS without delivery
  • 644.2 Early onset of delivery
  • [0-1] Onset (spontaneous) of delivery before 37 completed weeks of gestation
    • Premature labor with onset of delivery before 37 completed weeks of gestation
• 645 Prolonged pregnancy
• [0,1,3]
  • Requires fifth digit; valid digits are in [brackets] under each code. See beginning of section 640-648 for definitions.
  • Use 0 as fourth digit for category 645
    • Post term pregnancy
      • Pregnancy which has advanced beyond 42 weeks of gestation
• 646 Other complications of pregnancy, not elsewhere classified
  • Use additional code(s) to further specify complication
  • Requires fifth digit; valid digits are in [brackets] under each code. See beginning of section 640-648 for definitions.
  • 646.0 Papyraceous fetus
  • [0,1,3]
  • 646.1 Edema or excessive weight gain in pregnancy, without mention of hypertension
  • [0-4] Gestational edema
    • Maternal obesity syndrome
    • Excludes: that with mention of hypertension (642.0-642.9)
  • 646.2 Unspecified renal disease in pregnancy, without mention of hypertension
  • [0-4] Albuminuria in pregnancy or the puerperium, without mention of hypertension
    • Nephropathy NOS in pregnancy or the puerperium, without mention of hypertension
    • Renal disease NOS in pregnancy or the puerperium, without mention of hypertension
    • Uremia in pregnancy or the puerperium, without mention of hypertension
    • Gestational proteinuria in pregnancy or the puerperium, without mention of hypertension
    • Excludes: that with mention of hypertension (642.0-642.9)
  • 646.3 Habitual aborter
  • [0-1,3]
    • Excludes: with current abortion (634.0-634.9)
      • without current pregnancy (629.9)
  • 646.4 Peripheral neuritis in pregnancy
  • [0-4]
  • 646.5 Asymptomatic bacteriuria in pregnancy
  • [0-4]
  • 646.6 Infections of genitourinary tract in pregnancy
  • [0-4] Conditions classifiable to 590, 595, 597, 599.0, 616 complicating pregnancy, childbirth, or the puerperium
    • Conditions classifiable to 614-615 complicating pregnancy or labor
    • Excludes: major puerperal infection (670)
  • 646.7 Liver disorders in pregnancy
  • [0,1,3] Acute yellow atrophy of liver (obstetric) (true) of pregnancy
    • Icterus gravis of pregnancy
    • Necrosis of liver of pregnancy
    • Excludes: hepatorenal syndrome following delivery (674.8)
      • viral hepatitis (647.6)
  • 646.8 Other specified complications of pregnancy
  • [0-4] Fatigue during pregnancy
    • Herpes gestationis
    • Insufficient weight gain of pregnancy
  • 646.9 Unspecified complication of pregnancy
  • [0,1,3]
• 647 Infectious and parasitic conditions in the mother classifiable elsewhere, but complicating pregnancy, childbirth, or the puerperium
  • Use additional code(s) to further specify complication
  • Requires fifth digit; valid digits are in [brackets] under each code. See beginning of section 640-648 for definitions.
    • Includes: the listed conditions when complicating the pregnant state, aggravated by the pregnancy, or when a main reason for obstetric care
    • Excludes: those conditions in the mother known or suspected to have affected the fetus (655.0-655.9)
    • 647.0 Syphilis
    • [0-4] Conditions classifiable to 090-097
    • 647.1 Gonorrhea
    • [0-4] Conditions classifiable to 098
    • 647.2 Other venereal diseases
    • [0-4] Conditions classifiable to 099
    • 647.3 Tuberculosis
    • [0-4] Conditions classifiable to 010-018
    • 647.4 Malaria
    • [0-4] Conditions classifiable to 084
    • 647.5 Rubella
    • [0-4] Conditions classifiable to 056
    • 647.6 Other viral diseases
    • [0-4] Conditions classifiable to 042 and 050-079, except 056
    • 647.8 Other specified infectious and parasitic diseases
    • [0-4]
    • 647.9 Unspecified infection or infestation
    • [0-4]
• 648 Other current conditions in the mother classifiable elsewhere, but complicating pregnancy, childbirth, or the the puerperium
  • Use additional code(s) to identify the condition
  • Requires fifth digit; valid digits are in [brackets] under each code. See beginning of section 640-648 for definitions.
  • Includes: the listed conditions when complicating the pregnant state, aggravated by the pregnancy, or when a main reason for obstetric care
  • Excludes: those conditions in the mother known or suspected to have affected the fetus (655.0-665.9)
  • 648.0 Diabetes mellitus
  • [0-4] Conditions classifiable to 250
    • Excludes: gestational diabetes (648.8)
  • 648.1 Thyroid dysfunction
  • [0-4] Conditions classifiable to 240-246
  • 648.2 Anemia
  • [0-4] Conditions classifiable to 280-285
  • 648.3 Drug dependence
  • [0-4] Conditions classifiable to 304
  • 648.4 Mental disorders
  • [0-4] Conditions classifiable to 290-303, 305-316, 317-319
  • 648.5 Congenital cardiovascular disorders
  • [0-4] Conditions classifiable to 745-747
  • 648.6 Other cardiovascular diseases
  • [0-4] Conditions classifiable to 390-398, 410-429
    • Excludes: cerebrovascular disorders in the puerperium (674.0)
      • venous complications (671.0-671.9)
  • 648.7 Bone and joint disorders of back, pelvis, and lower limbs
  • [0-4] Conditions classifiable to 720-724, and those classifiable to 711-719 or 725-738, specified as affecting the lower limbs
  • 648.8 Abnormal glucose tolerance
  • [0-4] Conditions classifiable to 790.2
    • Gestational diabetes
  • 648.9 Other current conditions classifiable elsewhere
  • [0-4] Nutritional deficiencies [conditions classifiable to 260-269]