# Coding URI ER visit with pregnancy



## lsmft (Mar 25, 2011)

I had and ER visit, pregnancy, she came in with cough, congestion and sinusitis.  I had coded it as 786.0; 473.9 and V22.2.  One of the other coders suggests that it should be coded 648.93, 46539 and 473.9. She further said that even if it is not a pregnancy related illness it has to be coded as a pregnancy issue unless stated otherwise.

It this true??? If so I'd like to see some documentation to prove it. One of our coders said an auditor said the same but there is no documentation to support coding any and everything as pregnancy related even when it not.

HELP


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## sdunn (Mar 25, 2011)

648.93- the use of this code is related to any conditions  classifiable to other diseases. 648.93 is for gestational diabtes. I do not agree with use these codes. Just from what I am reading in the ICD-9. This is not a complication of the preganacy. Why would we give the patient a condition she does not have?  The only thing the provider in the ER is treating her for is a URI/with cough.

What did the provder treat? What was prescription for? 

Hope this helps.


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## mitchellde (Mar 25, 2011)

648.93 is NOT for gestational diabetes, that would be 648.83.  And the coders stating it must be 648.93 first listed are correct.  It is written in the coding guidelines as well as numerous coding clinics.  in the coding guidelines it states that we may use V22.2 only when documented by the provider that there is complication of the management of the preganancy.  It goes further to state that it is the providers responsibility to state that the condition being treated is not complicating the management of the pregnancy.  Chapter 11 coders (630-677) always have sequencing priority and always go first.  So if the patient comes to the ER or physician office for any problem and the provider does not state it is not complicating the management then we use a chapter 11 code first listed, in the above example it would be 648.93, a UTI would be 646.63 and so on.  The provider in the ER is NOT just treating the cough when the patient is pregnant.


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## lsmft (Mar 25, 2011)

Thank you Debra, That helps a lot.


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