Postpartum Hemorrhage: Documentation and Coding Considerations

Overview of Postpartum Hemorrhage

Postpartum hemorrhage (PPH) is a medical emergency that remains one of the leading causes of maternal morbidity and mortality worldwide.

Primary PPH is defined as a cumulative blood loss of at least 1 liter or more accompanied by signs of hypovolemia within 24 hours after delivery.

Clinical Indicators and Common Causes of Postpartum Hemorrhage

Uterine Atony

Uterine atony refers to the failure of the myometrium to contract, preventing effective compression of uterine blood vessels and leading to continued blood loss.

Common causes:

• Prolonged labor
• Multiple gestation pregnancy
• Polyhydramnios
• Prolonged oxytocin
• Uterine infections

Retention of Placenta

Incomplete removal of the placenta or the presence of retained amniotic membranes can lead to PPH.

Trauma to the Genital Tract

If the patient undergoes a vaginal delivery, lacerations of the cervix, vagina, and perineum may lead to significant hemorrhage.

Examples:

• Vaginal delivery with forceps
• Episiotomy
• Uterine inversion

Coagulopathies can preexist prior to pregnancy or be acquired.

Common causes include:

• Von Willebrand disease
• ITP
• DIC
• Placental abruption
• Preeclampsia
• Amniotic fluid embolism
• Sepsis

ICD-10-CM and ICD-10-PCS Coding for Postpartum Hemorrhage

Postpartum hemorrhage codes fall under Category O72.

The following classify as CCs:

• O72.0 Third-stage hemorrhage
• O72.1 Other immediate postpartum hemorrhage
• O72.2 Delayed and secondary postpartum hemorrhage

Current coding advice indicates that when a Bakri balloon is used to control bleeding, the root operation is "Control."

The full ICD-10-PCS code is: 0W3R7ZZ

CDI Review Opportunities for Postpartum Hemorrhage

Providers should link the etiology of a postpartum hemorrhage in the documentation.

Example: "Postpartum hemorrhage due to uterine atony."

Review for:

• Quantified blood loss
• Hypotension and tachycardia
• Altered mental status and syncope
• Drop in hemoglobin and hematocrit
• Coagulation abnormalities

Secondary conditions for review:

• Acute blood loss anemia
• DIC
• Hypovolemic shock
• Associated organ dysfunction

Common Treatments for Postpartum Hemorrhage

This section would include:

• Oxytocin
• Misoprostol
• Carboprost
• Blood products
• Balloon tamponade
• D&C
• Hysterectomy

Documentation Example

"Severe postpartum hemorrhage due to uterine atony with estimated blood loss of 1500 mL, resulting in acute blood loss anemia and requiring transfusion of 2 units PRBCs and uterotonic therapy."

CDI Query Example for Postpartum Hemorrhage

Dear Dr. Smith,

Documentation in the medical record reflects postpartum hemorrhage due to atony for this encounter. Please review the below clinical indicators and indicate the condition you are monitoring and treating. For example:

• Acute blood loss anemia due to postpartum hemorrhage
• Other explanation of clinical findings, please specify

Clinical findings/Documentation:

Progress note X/X:

"Patient experienced postpartum hemorrhage requiring 2 units of PRBC. Trending H&H. Values improving"

Hemoglobin:

• X/X 12.5
• X/X 11.4
• X/X 7.5

Risk Factors:

• Uterine atony with postpartum hemorrhage

Treatment/Monitoring:

• Transfusion of PRBC
• Serial labs
• Increased RN assessment frequency

Alyce Reavis, RN,MSN,CCDS,CCS 

Senior CDI Educator, Consulting Services at UASI

Drawing on clinical experience in adult, pediatric, and neonatal acute care, Alyce brings valuable insight to CDI education and documentation improvement. She holds an MSN in Leadership/Education along with CCDS, CCS, and AHIMA’s outpatient CDI micro credential, supporting health systems in strengthening documentation accuracy, quality reporting, and reimbursement integrity. Passionate about truthful, clinically aligned health records, she helps organizations ensure documentation reflects true patient acuity. She is a past presenter for the ACDIS National Convention, Local chapter meetings, and the ACDIS Virtual Best Practices conference. 

Works Cited

AHIMA/ACDIS. (2022). Guidelines for achieving a compliant query practice. Available at https://www.ahima.org/media/51ufzhgl/20221212_acdis_practice-brief.pdf

American Hospital Association. (2014). Postpartum hemorrhage coding guidance. Coding Clinic for ICD-10-CM/PCS, Fourth Quarter 2014, 44.

American College of Obstetricians and Gynecologists. (2017). Practice Bulletin: Postpartum hemorrhage. Available at https://www.acog.org/clinical/clinical-guidance/practice-bulletin/articles/2017/10/postpartum-hemorrhage

American Academy of Family Physicians. (2023). Practice guidelines: Postpartum hemorrhage. Available at https://www.aafp.org/afp/2023/0400/practice-guidelines-postpartum-hemorrhage.pdf

Association of Clinical Documentation Improvement Specialists. (2026). Q&A: Boosting consistency when reporting postpartum hemorrhage. Available at https://acdis.org/articles/qa-boosting-consistency-when-reporting-postpartum-hemorrhage