# ICD 9 Code for pregnancy and Allergic Rhinitis



## shwetajha_17 (Feb 25, 2014)

If a pregnant patient presenting with cough and sneezing and is diagnosed with Allergic Rhinitis, what will be the ICD 9 code be?


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## mitchellde (Feb 26, 2014)

You will need to code a chapter 11 code first (630-677).  Probably a 648.93 followed by the code for the allergic rhinitis.


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## SHERRYDUDLEY (Feb 27, 2014)

*My Opinion..*

If the rhinitis is "INCIDENTAL TO THE PREGNANCY" .....in other words not affecting the pregnancy, you would code the allergic rhinitis from that section of the dx codes not the maternity codes and use V22.2 (incidental to pregnancy) (?? I think??...I don't have my book in front of me) as the secondary code. If it is unrelated to the pregnancy you can bill an e&m with the modifier 24, at the time of service. 

IF, on the other hand, the pt is dehydrated or it is affecting the pregnancy in some other way you would use the maternity codes as mentioned above and unless there are frequent visits due to high risk conditions you cannot bill them outside of the final global delivery code.

This is clearly defined in the Medicare CCI edits.


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## mitchellde (Feb 27, 2014)

The physician is the only one that can determine if the pregnancy is incidental, the guidelines specify that "it is the provider's responsibility" to state whether the current condition is affecting the management of the pregnancy.  If the provider intends to prescribe a medication he will need to consider the number of weeks of gestation before he can complete the treatment plan which makes the pregnancy relevant and not incidental.


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## SHERRYDUDLEY (Feb 28, 2014)

*Yes and No*

I agree that the doctor decides and documents if the problem is affecting the pregnancy......Obviously?!..... and I didn't say otherwise??

But the fact that provider prescribes a medication during pregnancy does not automatically mean that the problem is pregnancy related and should be billed with the complications of pregnancy dx codes.


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## mitchellde (Feb 28, 2014)

The doctor has to document if the problem is NOT affecting the pregnancy.  The coder must code using the chapter 11 codes first listed.  V22.2 can only be used if the provider documents this.  Anytime a medication is prescribed the provider must take into account the stage of the pregnancy.  The problem does not need to be pregnancy related only that the treatment affect the management of the pregnancy and any medication does.  Look at 648 codes .. Other current condition affecting the management of the pregnancy.  
So another way to state this is the coder always assumes every condition will affect the pregnancy until the provider states otherwise.


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## SHERRYDUDLEY (Feb 28, 2014)

*Copy of article to support ob coding & use of V22.2*

(There is nothing mentioned in anything I have read that states if medication is prescribed to an ob pt for a non-pregnancy problem that it then becomes pregnancy related) 

COPY OF ARTICLE:

Diagnosis Codes Must Reflect Fact

The chart should tell you what the code is. Knowledgeable coding consultants continually emphasize that among the thousands of codes in the ICD-9, you must chose the codes that best reflect the complete chart and the picture of what is going on with your patient. For example, a woman in her second trimester of pregnancy presents with multiple varicose veins in her left leg with severe superficial phlebitis. ICD-9 coding for the office visit might appear to include a 454.9 (varicose veins of the lower extremities), 451.0 (phlebitis and thromophlebitis of superficial vessels of lower extremities), and V22.0 (supervision of normal pregnancy).  Instead, you should use 671.03 (antepartum varicose veins of legs) and 671.23 (superficial thrombophlebites). These codes reflect the complete facts.

On the other hand, if a pregnant patient presents with a problem NOT related to pregnancy, such as flu, code the condition the patient came in with and then use the V code V22.2 for the management of the pregnancy as incidental


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## mitchellde (Feb 28, 2014)

I did not say it was pregnancy related, it does however affect the management.  If a provider wants to prescribe an antibiotic they must first take into consideration the number of weeks of gestation.  The coding guidelines state that it is the providers responsibility to state that the condition is NOT affecting the management of the pregnancy to use the V22.2.  I am sorry you disagree, but if you use the V22.2 then you are coding something the provider did not document.  
ICD-10 cod make this much more clear and I encourage you to look at them.  Also the article you use supports that it should not be coded with the V22.2.  Treatment of the flu does affect the management of the pregnancy.


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## SHERRYDUDLEY (Feb 28, 2014)

*Another article*

Coders Notebook

The following tips will assist you in coding both the routine and complicated obstetrical patient. 

1. Initial visit. This first visit is not part of the global package because the patient was diagnosed as being pregnant at this visit. If she had come in with a positive pregnancy test, this visit would have been the initial ob visit and part of the package. You will code the first visit using the E/M code 9920X, new patient encounter, linked to a diagnosis of 626.8, suppression of menstruation. Note: you cannot code 626.0, amenorrhea, because in order to use this code the patient must have had no period for three months, and this is only one missed period. 

2. Non-antepartum visit. During her 21st week, Angela is seen for a UTI. This visit is outside the global and will be coded using the visit code 9921X, established patient encounter. The diagnosis code you use for this visit depends on whether the UTI is complicating pregnancy. If it is not (and only the physician can make this decision), you will code the visit as 599.0, UTI, and V22.2, pregnancy incidental. If the UTI is complicating the pregnancy, code the diagnosis as 646.63, GU infection in pregnancy.


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## mitchellde (Feb 28, 2014)

SHERRYDUDLEY said:


> Coders Notebook
> 
> The following tips will assist you in coding both the routine and complicated obstetrical patient.
> 
> ...



The coding guidelines will supercede this information also coding clinics have written numerous instructions on this topic.  There are also many threads in this forum on this topic.  The provider must state is is NOT affecting the pregnancy not the other way around.  You must use official sources for information, such as coding guidelines and coding clinics.  Any person many author an article but without source reference it does not make it correct.


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## SHERRYDUDLEY (Feb 28, 2014)

*Not disputing*

I'm not disputing the fact that the dr needs to document that the problem is not affecting the management of the pregnancy. I AGREE WITH YOU 100% ON THAT.

I'm disputing the fact that you said....(or what I thought you said?) Is that just because a medication is prescribed during pregnancy for an unrelated pregnancy problem means you have to use a pregnancy dx code (starting at640-).

Also, I don't understand what you mean here?? Where does it say tx of the flu affects the mgmt of the preg? or that V22.2 should not be used??

 "Also the article you use supports that it should not be coded with the V22.2. Treatment of the flu does affect the management of the pregnancy"

This is what the article said:
"On the other hand, if a pregnant patient presents with a problem NOT related to pregnancy, such as flu, code the condition the patient came in with and then use the V code V22.2 for the management of the pregnancy as incidental"


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## mitchellde (Feb 28, 2014)

I thought that line was yours and not the article mt apologies.  What that line intimates is that the coder should always code V22.2 when the dx is the flu and the patient is pregnant and that is not true.  The provider must state that the pregnancy is incidental to the flu.  The physicians that I work with and the ones I teach are the ones that tell me any medication treatment affects the pregnancy, antibiotics will depend on the trimester, and even tylenol must be recommended with care.  So only if the provider states something like "patient with flu, with incidental pregnancy" would you use V22.2.


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## Bready (Feb 28, 2014)

Sherry & Debra,
It was delightful to read your ongoing discussion on correct coding of pregnancy incidental "V22.2".  We help and learn from each other.

Sherry if you read closely your document you will see that it actually supports Debra's position.  "If it(allergic rhinitis) is not affecting the pregnancy (and only the physician can make the decision)...those are the key words"only the physician can make the decision"....in other words THE PHYSICIAN HAVING MADE THE DECISION THAT THE ALLERGIC RHINITIS DOES NOT AFFECT THE PREGNANCY MUST MAKE THAT DOCUMENTATION.  If he does not document his decision that it is not affecting the pregnancy, then it is affecting the pregnancy and is coded as Debra states.

I don't know if your physician is family practice or OB, but the OBs I work for are adament that EVERYTHING affects the management of the pregnancy because as Debra states the treatment of the mother is also the treatment of the unborn baby so gestational age is important for the administration of any drugs.  
The debate was excellent. Good for you for standing your ground, Sherry, but the correct answer is Debra's.


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