ICD-10 Coding for Postpartum Uterine Atony
The correct ICD-10 code for postpartum uterine atony is O72.1 (Other immediate postpartum hemorrhage) when hemorrhage is present, or O75.89 (Other specified complications of labor and delivery) for atony without significant hemorrhage.
Primary Coding Considerations
Uterine atony with hemorrhage requires O72.1, as uterine atony accounts for 70-80% of all postpartum hemorrhage cases and is the leading cause of early PPH within the first 24 hours after delivery 1.
The timing of diagnosis matters for coding accuracy: immediate postpartum hemorrhage (within 24 hours) uses the O72 series, while delayed hemorrhage (24 hours to 12 weeks postpartum) would use O72.2 1.
Coding Algorithm Based on Clinical Presentation
Step 1: Determine if hemorrhage is present
- If blood loss >500 mL after vaginal delivery or >1000 mL after cesarean delivery with documented uterine atony (soft, boggy uterus), use O72.1 2, 1.
- If uterine atony is diagnosed clinically but hemorrhage criteria are not met, use O75.89 as the most appropriate code for the complication.
Step 2: Assess uterine tone to confirm atony
- Uterine atony presents with a soft, boggy uterus that fails to contract properly, which is effectively a clinical diagnosis 2, 1.
- A firm, well-contracted uterus rules out atony as the cause of bleeding—in this case, genital tract laceration becomes the leading diagnosis and requires different coding 1.
Step 3: Document associated complications
- If coagulopathy develops following cardiovascular collapse or massive transfusion, add appropriate secondary codes from the D65-D69 series 2.
- If surgical interventions are performed (uterine artery ligation, B-Lynch suture, hysterectomy), add procedure codes accordingly 2.
Common Coding Pitfalls to Avoid
Do not code based solely on the presence of hemorrhage without confirming uterine tone: A patient with postpartum bleeding and a firm uterus after vaginal delivery has genital tract laceration as the most common cause, not atony, requiring different ICD-10 coding 1.
Avoid misclassifying timing: Retained products of conception (RPOC) complicate approximately 1% of third-trimester deliveries and is the second most common etiology for PPH after uterine atony, but this is typically seen in the delayed PPH population (>24 hours), which requires O72.2 coding 3, 1.
Do not confuse amniotic fluid embolism with atony: Hemorrhage from persistent atony with secondary coagulopathy should not be misdiagnosed as amniotic fluid embolism based solely on the hemorrhage presentation 2.
Documentation Requirements for Accurate Coding
Document the clinical assessment of uterine tone (soft/boggy versus firm) in the medical record, as this is the key distinguishing feature for atony 2, 1.
Record quantitative blood loss measurements to support hemorrhage coding, as this determines whether O72.1 is appropriate 4.
Note the response to uterotonic medications (oxytocin, methylergonovine, carboprost) and uterine massage, as refractory atony may require additional documentation for severity 2, 5.
Document any surgical or interventional radiology procedures performed (uterine tamponade, compression sutures, uterine artery embolization, hysterectomy) to support additional procedure codes 2, 4.