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31.3.3.1 Classification of Risk
Low risk
A client with a normal evaluation without substantial risk factors at the initial examination and each subsequent examination is low risk. The number of antepartum care visits does not usually exceed 20 and the number of usual postpartum visits is 2.
High risk
A client with an identified complication or risk factor that might adversely affect the mother or fetus is high risk. Examples of common high-risk pregnancy factors are listed in the following table with the appropriate diagnosis code, but not all high-risk factors are listed. Providers submitting charges for high-risk antepartum care must document the high-risk diagnosis on the claim form.
• Maternal client is younger than 17 years of age or older than 35 years of age (V2381, V2382, V2383, V2384).
•Nutritional problems:
•Underweight-30 percent underweight before pregnancy (V2389). Calculations of weight are based on actual weight compared to the standard height/weight charts nationally.
•Failure to gain weight appropriately (64680).
•Weight loss greater than 10 pounds during pregnancy (V2389, 64890)
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