Obstetrical Hypertension Programs
Last Review: 04/09/2021 Effective: 02/14/2000 Next Review: 03/24/2022 Number: 0368
*Please see amendment for Pennsylvania Medicaid at the end of this CPB.
Aetna considers obstetrical hypertension programs experimental and investigational because they have not been proven to be more effective than member self-management performed in concert with supervision by an obstetrician in reducing fetal or maternal morbidity and mortality.
Obstetrical hypertension programs offer a "package" approach to the outpatient care of the hypertensive pregnant patient. These programs typically use a device to measure blood pressure and pulse, and to transmit measurements of daily weight, fetal movement count, and urine proteinuria. The programs do not assure patient compliance with physician instructions regarding the ambulatory management hypertension.
For mild preeclampsia, conservative management is recommended by the American College of Obstetricians and Gynecologists (ACOG) for any woman not undergoing delivery. Conservative management involves monitoring the patient's blood pressure, proteinuria, renal and hepatic function, platelet counts, and serial sonography for fetal growth. The frequency with which these parameters are monitored should depend on
gestational age and circumstance of the patient and fetus. Inpatient or outpatient management may be appropriate.
Code Code Description
S9211 Home management of gestational hypertension, includes administrative services, professional pharmacy services, care coordination and all necessary supplies and equipment (drugs and nursing visits coded separately); per diem (do not use this code with any home infusion per diem code)
S9212 Home management of postpartum hypertension, includesadministrativeservices,professionalpharmacy services, care coordination and all necessary supplies and equipment (drugs and nursing visits coded separately); per diem (do not use this code with any home infusion per diem code)
S9213 Home management of preeclampsia, includes
administrativeservices,professionalpharmacyservices, care coordination and all necessary supplies and equipment (drugs and nursing visits coded separately);
per diem (do not use this code with any home infusion per diem code)
O10.011 - O10.019 O10.911 - O10.919
Hypertensive heart disease and hypertension
complicating pregnancy, childbirth, and the puerperium
Code Code Description
O10.111 - O10.119, O10.211 - O10.219, O10.311 - O10.319, O11.1 - O11.9
Other pre-existing hypertension complicating pregnancy, childbirth, and the puerperium
O10.411 - O10.419
Hypertensionsecondary,complicatingpregnancy, childbirth, and the puerperium
O11.1 - O11.9
Pre-existing hypertensive disorder with superimposed proteinuria
O13.1 - O13.9
Gestational (pregnancy induced) hypertension without significant proteinuria
O14.00 - O14.03 O14.90 - O14.95
Gestational (pregnancy induced) hypertension with significant proteinuria
O14.10 - O14.13
Severe pre-eclampsia
O15.00 - O15.9
Eclampsia in pregnancy
O16.1 - O16.9
Unspecified maternal hypertension
1. Abalos E, Duley L, Steyn DW, Henderson-Smart DJ.
Antihypertensive drug therapy for mild to moderate
hypertension during pregnancy. Cochrane Database Syst Rev.
2007;(1):CD002252.
2. Alavifard S, Chase R, Janoudi G, et al. First-line antihypertensive treatment for severe hypertension in pregnancy: A systematic review and network meta-analysis. Pregnancy Hypertens.
2019;18:179-187.
3. American College of Obstetrics and Gynecology (ACOG). Chronic hypertension in pregnancy. ACOG Practice Bulletin No. 29.
Washington, DC: ACOG; July 2001.
4. Bergel E, Carroli G, Althabe F. Ambulatory versus conventional methods of blood pressure monitoring during pregnancy.
Cochrane Database Syst Rev. 2002;(2):CD001231.
5. Crowther CA, Bouwmeester AM, Ashurst HM. Does admission to hospital for bed rest prevent disease progression or improve fetal outcome in pregnancy complicated by non-proteinuric hypertension . Br J Obstet Gynaecol.1992;99(1):13-17.
6. Davenport MH, Ruchat SM, Poitras VJ, et al. Prenatal exercise for the prevention of gestational diabetes mellitus and hypertensive disorders of pregnancy: A systematic review and meta-analysis.
Br J Sports Med. 2018;52(21):1367-1375.
7. Ferrer RL, Sibai BM, Mulrow CD, et al. Management of mild chronic hypertension during pregnancy: A review. Obstet Gynecol. 2000;96(5 Pt 2):849-860.
8. Hirshberg A, Downes K, Srinivas S, et al. Comparing standard office-based follow-up with text-based remote monitoring in the management of postpartum hypertension: A randomised clinical trial. BMJ Qual Saf. 2018;27(11):871-877.
9. Honigberg MC, Zekavat SM, Aragam K, et al. Long-term cardiovascular risk in women with hypertension during pregnancy. J Am Coll Cardiol. 2019;74(22):2743-2754.
10. Mathews DD. A randomized controlled trial of bed rest and sedation or normal activity and non-sedation in the management of non-albuminuric hypertension in late pregnancy. Br J Obstet Gynaecol. 1977;84(2):108-114.
11. Maxwell CV, Amankwah KS. Alternative approaches to preterm labor. Semin Perinatol. 2001;25(5):310-315.
12. Mulrow CD, Chiquette E, Ferrer RL, et al. Management of chronic hypertension during pregnancy. Evidence Report/Technology
Assessment 14. Rockville, MD: Agency for Healthcare Research and Quality (AHRQ); 2000.
13. No authors listed. National High Blood Pressure Education Program Working Group Report on High Blood Pressure in Pregnancy. Am J Obstet Gynecol. 1990;163(5 Pt 1):1691-1712.
14. Roberts JM. Pregnancy-related hypertension. In: Maternal Fetal Medicine. 3rd ed. RK Creasy, R Resnik, eds, Philadelphia, PA: WB Saunders Co.; 1994:804-843.
15. Scott JR. Hypertensive disorders of pregnancy. In: Danforth's Obstetrics and Gynecology. 7th ed. JR Scott, PJ Disaia, CB Hammond, WN Spellacy, eds, Philadelphia, PA: JB Lippincott Company; 1994:351-365.
16. Shireen M, Edgardo A, Guillermo C. Bed rest with or without hospitalisation for hypertension during pregnancy.Cochrane Database Syst Rev. 2005;(4):CD003514.
17. Sibai BM, Barton JR, Akl S, et al. A randomized prospective comparison of nifedipine and bed rest versus bed rest alone in the management of preeclampsia remote from term. Am J Obstet Gynecol. 1992;167(4 Pt 1):879-884.
Copyright Aetna Inc. All rights reserved. Clinical Policy Bulletins are developed by Aetna to assist in administering plan benefits and constitute neither offers of coverage nor medical advice. This Clinical Policy Bulletin contains only a partial, general description of plan or program benefits and does not constitute a contract. Aetna does not provide health care services and, therefore, cannot guaranteeany results or outcomes. Participating providers are independent contractors in private practice and are neither employees nor agents of Aetna or its affiliates. Treating providers are solely responsible for medical advice and treatment of members. This Clinical Policy Bulletin may be updated and therefore is subject to change.
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AETNA BETTER HEALTH® OF PENNSYLVANIA
Amendment to
Aetna Clinical Policy Bulletin Number: 0368 Obstetrical Hypertension Programs
There are no amendments for Medicaid.
annual 07/01/2021
