# Not sure how to code this...



## vickizenier (Jan 3, 2012)

I have to code pregnant 3 months abdominal pain. That is all the information that I have. Any idea???


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## BABS37 (Jan 3, 2012)

646.83 implies a 'complication to pregnancy' which the documentation you have does not support that code. Use 648.93 - current conditions in mother- with 789.00.


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## vickizenier (Jan 3, 2012)

Thanks! That was the problem I had because it didn't say that it was related to the pregnancy.


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## BABS37 (Jan 3, 2012)

You're welcome! I did OB/GYN and Woman's Health and there's a lot of controversial issues with OB coding but the one thing I learned was, if the doc doesn't say its a complication, then it isn't. The same goes with UTI's, which I always thought would be a complication but then I took a class  Anyway, glad to have helped!


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## ajs (Jan 3, 2012)

vickizenier said:


> I have to code pregnant 3 months abdominal pain. That is all the information that I have. Any idea???



If you read the Official guidelines at the front of the ICD-9 book for Chapter 11 it states:

 "Obstetric cases require codes from chapter 11, codes in the range 630-679, Complications of Pregnancy, Childbirth, and the Puerperium.  Chapter 11 codes have sequencing priority over codes from other chapters.  Additional codes from other chapters may be used in conjunction with chapter 11 codes to further specify conditions.  Should the provider document that the pregnancy is incidental to the encounter, then code V22.2 should be used in place of any chapter 11 codes.  It is the provider's responsibility to state that the condition being treated is not affecting the pregnancy."

This means that unless the provider says the abdominal pain is not affecting the pregnancy, you must default to a complication code in the 630-679 codes in Chapter 11.  If the provider states in the record that the condition is not affecting the pregnancy, then you may use a code from the other chapters and use V22.2 to indicate that the patient is also pregnant.


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## ajs (Jan 3, 2012)

bbierman81 said:


> You're welcome! I did OB/GYN and Woman's Health and there's a lot of controversial issues with OB coding but the one thing I learned was, if the doc doesn't say its a complication, then it isn't. The same goes with UTI's, which I always thought would be a complication but then I took a class  Anyway, glad to have helped!



Actually, unless the doctor states in the record that the condition IS NOT affecting the pregnancy, you must use a complication code.  See the ICD-9 guidelines at the front of the book.  This is one of the times when the guidelines are opposite what we usually look for as coders.  UTIs are a complication of pregnancy unless your provider clearly states in the record that it IS NOT complicating the pregnancy.  A lot of OB coders get this wrong.


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## vickizenier (Jan 3, 2012)

Ok, I am confused . Would I use 646.83 and 789.00 along with the V22.2 code?


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## mitchellde (Jan 3, 2012)

vickizenier said:


> Ok, I am confused . Would I use 646.83 and 789.00 along with the V22.2 code?



No you would use the 648.93 with the 780.00 you will not use the V22.2 as it is not documented for.  Since he has not stated the abd pain is a complication of the pregnancy we must assume it is a condition that will affect the management of the pregnancy we cannot use the V22.2 unless the provider states the condition is not a complication or is not affecting the pregnancy.


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## vickizenier (Jan 3, 2012)

Thanks Debra!!!


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## BABS37 (Jan 4, 2012)

ajs said:


> Actually, unless the doctor states in the record that the condition IS NOT affecting the pregnancy, you must use a complication code.  See the ICD-9 guidelines at the front of the book.  This is one of the times when the guidelines are opposite what we usually look for as coders.  UTIs are a complication of pregnancy unless your provider clearly states in the record that it IS NOT complicating the pregnancy.  A lot of OB coders get this wrong.



Yes, I realize that a UTI would be assumed a complication of pregnancy, however, not a single one of our physicians considered it a complication of pregnancy so it could never be coded as that. It had to be coded as a condition affecting the management of the mother. We rarely ever used 646.8X for complications. We code by documentation only from the physician and patient charts and if it wasn't documented as complication- then it wasn't. 

"The same principle applies if the patient had a urinary tract infection (UTI), which is common in pregnancy. If the physician considered the UTI as unrelated to the pregnancy, the visit would be billed at the appropriate E/M level for an established patient (99211-99215), linked to diagnostic codes 599.0 (urinary tract infection, site not specified) and V22.2." This is how we coded. And not only that but it changes the billing guidelines with OB Global- if it's not related, it can be billed out as a separate charge unrelated to the pregnancy.


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## ajs (Jan 4, 2012)

babierman said:


> Yes, I realize that a UTI would be assumed a complication of pregnancy, however, not a single one of our physicians considered it a complication of pregnancy so it could never be coded as that. It had to be coded as a condition affecting the management of the mother. We rarely ever used 646.8X for complications. We code by documentation only from the physician and patient charts and if it wasn't documented as complication- then it wasn't.
> 
> "The same principle applies if the patient had a urinary tract infection (UTI), which is common in pregnancy. If the physician considered the UTI as unrelated to the pregnancy, the visit would be billed at the appropriate E/M level for an established patient (99211-99215), linked to diagnostic codes 599.0 (urinary tract infection, site not specified) and V22.2." This is how we coded. And not only that but it changes the billing guidelines with OB Global- if it's not related, it can be billed out as a separate charge unrelated to the pregnancy.



The point is that you can code the unrelated UTI in the pregnant patient as long as the physician has stated in the record that the condition is not affecting the pregnancy.  It is all about the documentation, not the intention.  If the physician did not state that the UTI is not affecting the pregnancy, then correct coding rules state you must use 646.6x.  This is one area of ICD-9 coding that is different, you cannot assume the condition is not a complication, the documentation must state it.  This is in the ICD-9 Official Guidelines for Coding and Reporting on page 14 in the front of the book.


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## BABS37 (Jan 4, 2012)

I'm not trying to disrespect you- clearly we both have misunderstood something at some point- I said my physician doesn't document and according to the guidelines you are referring to-  _"Obstetric cases require codes from chapter 11, codes in the range 630-679, Complications of Pregnancy, Childbirth, and the Puerperium. Chapter 11 codes have sequencing priority over codes from other chapters. Additional codes from other chapters may be used in conjunction with chapter 11 codes to further specify conditions. Should the provider document that the pregnancy is incidental to the encounter, then code V22.2 should be used in place of any chapter 11 codes. It is the provider's responsibility to state that the condition being treated is not affecting the pregnancy."_ it doesn't tell me that I have to assume its a complication. I was under the impression that it must be stated that the condition is complicating the pregnancy, and if it's not I revert to section E or the little e:  under Current Conditions Complicating to Pregnancy- Assign a code from subcategory 648.X for patients that have current conditions when the condition affects the management of the pregnancy, childbirth, or the puerperium. Use additional secondary codes from other chapters to identify the conditions, as appropriate. 

It is the provider's responsibility to state that the condition being treated is not affecting the pregnancy. If the physician doesn't state the condition is affecting the pregnancy, then why would I assume its a complication? Wouldn't I have to assume he'd need to state its a complication as well? I assumed this statement went with the sentence prior with V22.2 guidelines. 

Anyhow, either way, coding is open to interpretation and its always good to see other view points. I don't believe one way is wrong over the other. I've only been doing this for 8 years and I know every day is a learning experience in coding world.


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## ajs (Jan 4, 2012)

babierman said:


> I'm not trying to disrespect you- clearly we both have misunderstood something at some point- I said my physician doesn't document and according to the guidelines you are referring to-  _"Obstetric cases require codes from chapter 11, codes in the range 630-679, Complications of Pregnancy, Childbirth, and the Puerperium. Chapter 11 codes have sequencing priority over codes from other chapters. Additional codes from other chapters may be used in conjunction with chapter 11 codes to further specify conditions. Should the provider document that the pregnancy is incidental to the encounter, then code V22.2 should be used in place of any chapter 11 codes. It is the provider's responsibility to state that the condition being treated is not affecting the pregnancy."_ it doesn't tell me that I have to assume its a complication. I was under the impression that it must be stated that the condition is complicating the pregnancy, and if it's not I revert to section E or the little e:  under Current Conditions Complicating to Pregnancy- Assign a code from subcategory 648.X for patients that have current conditions when the condition affects the management of the pregnancy, childbirth, or the puerperium. Use additional secondary codes from other chapters to identify the conditions, as appropriate.
> 
> It is the provider's responsibility to state that the condition being treated is not affecting the pregnancy. If the physician doesn't state the condition is affecting the pregnancy, then why would I assume its a complication? Wouldn't I have to assume he'd need to state its a complication as well? I assumed this statement went with the sentence prior with V22.2 guidelines.
> 
> Anyhow, either way, coding is open to interpretation and its always good to see other view points. I don't believe one way is wrong over the other. I've only been doing this for 8 years and I know every day is a learning experience in coding world.



You are right...it is a learning experience. I learn something new everyday.  The rule regarding ICD-9 coding for OB I learned from an AAPC sponsored OB/Gyn seminar a long time ago and it was backed up when the question came up in the Specialty exam I took for my credential.  Maybe there are other interpretations...


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