Preterm labor w preterm delivery, unsp trimester, unsp

This code signifies the occurrence of labor leading to delivery before 37 completed weeks of gestation, where the specific trimester of delivery is not documented or is not applicable. It indicates a premature birth event without further detail regarding the gestational period at the time of delivery.

Apply this code when documentation confirms preterm labor resulting in preterm delivery, but the specific trimester of delivery is absent or cannot be determined. This is appropriate when the medical record simply states "preterm labor with preterm delivery" without further gestational age detail.

• Avoid using this code if the trimester of delivery is clearly documented; instead, select a more specific O60.1x code.
• Ensure documentation explicitly states both "preterm labor" and "preterm delivery" to support this code.
• Always sequence this code as a primary diagnosis when it represents the reason for the encounter.