# Trimester question



## amccracken1108 (Jul 18, 2018)

Our OB/GYN department tells us when coding the trimesters that 12 weeks is the 2nd trimester.  We explain for coding purposes this is the 1st trimester.  They wont change their assessment that states "2nd trimester" and also selects the code for 2nd trimester.  They told us they wont change what is done clinically for coding purposes.  Has anyone come across this problem before?


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## ahguzman (Jul 18, 2018)

I've never encountered this.   

Per ICD Manual:  Trimesters are counted from the first day of the last menstrual period.  They are defined as follows:

                          1st trimester- less than 14 weeks 0 days
                          2nd trimester- 14 weeks 0 days to less than 28 weeks 0 days
                          3rd trimester- 28 weeks 0 days until delivery

ACOG defines first trimester as first thirteen weeks of pregnancy. 

Do you have an example?


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## amccracken1108 (Jul 19, 2018)

There really is no example.  The entire department states that the 2nd trimester starts at 12 weeks.  

The providers response to us was "clinically the 2nd trimester starts at 12 weeks 1 day" and then stated "Im not comfortable changing medically correct clinical data to meet coding issues."


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## cgaston (Jul 19, 2018)

I think you all are getting hung up on the words rather than the facts. 

The fact is that the patient is 12w1d pregnant. The code for 12w1d pregnant is the code for 12w1d pregnant no matter what trimester it is called.  

The doctor can _call _it the second trimester in the chart and the ICD10 can _call_ it the first trimester but you would follow the ICD guidelines when selecting the code for 12w1d pregnant.


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## amccracken1108 (Jul 20, 2018)

I guess its more of a bigger deal  to us, because at our facility we aren't "coding".  we are reviewing  the codes selected against the documentation.  They select the 2nd trimester code when it should be selected as 1st trimester.  We do not, at our facility per policies, have the authority to change it.  The change has to come from the provider, so their responses are what they tell us as stated above.

They select icd10 Z34.92 and we should technically be selecting Z34.91, since we can't change it we have to query the provider to change it and they refuse.

Is this making more sense now of why we are hung up on it?


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## cgaston (Jul 20, 2018)

Until they change their policy to allow Coders to code, I believe that the only thing you can do is document in the patient's file that you brought the discrepancy up to the provider and he/she has refused to to follow the icd-10 guidelines.


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## Cmama12 (Jul 24, 2018)

Never heard of this situation!  But we have to follow ICD 10, so if the weeks of pregnancy is stated in the chart, code to the correct trimester.  Edited to say: ooh  I see you can't change the codes


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