Back to HomeBeta

ICD-10 Coding for Premature Rupture of Membranes(O42.011, O42.12)

Complete ICD-10-CM coding and documentation guide for Premature Rupture of Membranes. Includes clinical validation requirements, documentation requirements, and coding pitfalls.

Also known as:

PROMPrelabor Rupture of Membranesspontaneous rupture membranes

Quick Navigation

Related ICD-10 Code Ranges

Complete code families applicable to Premature Rupture of Membranes

O42Primary Range

Premature rupture of membranes

This range includes all codes related to premature rupture of membranes, specifying gestational age and time to labor onset.

Code Comparison: When to Use Each Code

Compare key differences between these codes to ensure accurate selection

CodeDescriptionWhen to UseKey Documentation
O42.011Preterm premature rupture of membranes, onset of labor within 24 hours of rupture, first trimesterUse when PROM occurs before 37 weeks and labor begins within 24 hours.
  • Gestational age <37 weeks
  • Labor onset within 24 hours of rupture
O42.12Term premature rupture of membranes, labor delayed by more than 24 hoursUse when PROM occurs at or after 37 weeks and labor is delayed by more than 24 hours.
  • Gestational age ≥37 weeks
  • Labor onset more than 24 hours after rupture

Clinical Decision Support

Always review the patient's clinical documentation thoroughly. When in doubt, choose the more specific code and ensure documentation supports it.

Key Information: ICD-10 code for premature rupture of membranes

Essential facts and insights about Premature Rupture of Membranes

The ICD-10 code for premature rupture of membranes depends on gestational age and labor onset, such as O42.011 for preterm PROM with labor within 24 hours.

Primary ICD-10-CM Codes for premature rupture of membranes

O42.011
Preterm premature rupture of membranes, onset of labor within 24 hours of rupture, first trimester
Billable Code

Decision Criteria

clinical Criteria

  • PROM occurs before 37 weeks with labor onset within 24 hours.

Applicable To

  • Preterm PROM with labor onset within 24 hours

Excludes

  • Full-term PROM
  • PROM without labor

Clinical Validation Requirements

  • Gestational age <37 weeks
  • Labor onset within 24 hours of rupture

Code-Specific Risks

  • Incorrect gestational age documentation
  • Misclassification of labor onset timing

Coding Notes

  • Ensure accurate documentation of gestational age and timing of labor onset.
View Full Code Details

Ancillary Codes

Additional codes that should be used in conjunction with the main diagnosis codes when applicable.

32 weeks gestation of pregnancy

Z3A.32
Use to specify gestational age when coding PROM.

38 weeks gestation of pregnancy

Z3A.38
Use to specify gestational age when coding PROM.

Differential Codes

Alternative codes to consider when ruling out similar conditions to the primary diagnosis.

Term premature rupture of membranes, labor delayed by more than 24 hours

O42.12
Use for PROM at or after 37 weeks with labor onset after 24 hours.

Preterm premature rupture of membranes, onset of labor within 24 hours of rupture, first trimester

O42.011
Use for PROM before 37 weeks with labor onset within 24 hours.

Documentation & Coding Risks

Avoid these common documentation and coding issues when documenting Premature Rupture of Membranes to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code O42.011.

Impact

Clinical: Inaccurate clinical records., Regulatory: Non-compliance with coding standards., Financial: Potential for denied claims.

Mitigation Strategy

Train staff on importance of detailed documentation., Implement checklists for PROM documentation.

Impact

Reimbursement: Potential for reduced reimbursement due to lack of specificity., Compliance: Non-compliance with coding guidelines., Data Quality: Decreased accuracy in clinical data reporting.

Mitigation Strategy

Ensure specific gestational age and labor onset timing are documented and coded.

Impact

Inaccurate or missing gestational age documentation can lead to coding errors.

Mitigation Strategy

Implement mandatory fields for gestational age in electronic health records.

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 Premature Rupture of Membranes, with expert answers to help guide accurate code selection and documentation.

Documentation Templates for Premature Rupture of Membranes

Use these documentation templates to ensure complete and accurate documentation for Premature Rupture of Membranes. These templates include all required elements for proper coding and billing.

Preterm PROM with labor onset within 24 hours

Specialty: Obstetrics

Required Elements

  • Gestational age
  • Timing of rupture
  • Labor onset timing
  • Diagnostic tests

Example Documentation

Patient at 32 weeks gestation presented with PROM. Labor began 18 hours post-rupture. Confirmed by positive nitrazine test and ultrasound.

Examples: Poor vs. Good Documentation

Poor Documentation Example
Patient reports fluid leak.
Good Documentation Example
PROM confirmed at 32 weeks with labor onset 18 hours later. Positive nitrazine test.
Explanation
The good example provides specific gestational age, timing, and diagnostic confirmation.

Need help with ICD-10 coding for Premature Rupture of Membranes? Ask your questions below.

Ask about any ICD-10 CM code, or paste a medical note

We build tools for
clinician happiness.

Learn More at Freed.ai
Back to HomeBeta

Built by Freed

Try Freed for free for 7 days.

Learn more

Helpful Links

How ICD 10 AI Lookup WorksContact UsPrivacy Policy