Anesthesia Coding Alert

You might be able to bump up P code assignment as well.

When coding for anesthesia during labor and delivery, it's important to also be aware of underlying diagnoses that could affect how your provider administers anesthesia – and how you code for it.

One diagnosis that saw several changes for 2017 is gestational diabetes.

"Changes to the gestational diabetes codes bring us to the complete picture," says Melanie Witt, RN, MA, independent ob-gyn consultant in Guadalupita, N.M. "Until now, we only had code for dietary and insulin control of gestational diabetes. In October, we will add control with hypoglycemic agents (such as Glyburide or Metformin)," Witt says. "These options for treatment are much more common."

Important: The tabular index will also include a note to use an additional code to identify the type of control using new code Z79.84 (Long term [current] use of oral hypoglycemic drugs) with all type 2 diabetic codes. This means that if you are reporting either an E11 code (type 2 diabetes) or an O24.1- code, Z79.84 will need to be also reported if the patient is taking oral medication. This new code will not be reported with the gestational diabetes codes, since the new codes include this information. As a reminder, correct coding for a type 2 diabetic pregnant patient would require reporting O24.1-, an E11 code for manifestations, and either Z79.4 for insulin control or new code Z79.84 for hypoglycemic control.

Take note of the following revisions:

• O24.01- (Pre-existing diabetes mellitus, type 1, in pregnancy ...) will become (Pre-existing type 1 diabetes mellitus, in pregnancy ...) with the sixth digit specifying trimester.
• O24.02 (Pre-existing diabetes mellitus, type 1, in childbirth) will become (Pre-existing type 1 diabetes mellitus, in childbirth).
• O24.03 (Pre-existing diabetes mellitus, type 1, in the puerperium) will become (Pre-existing type 1 diabetes mellitus, in the puerperium).
• O24.11- (Pre-existing diabetes mellitus, type 2, in pregnancy, ...) will become (Pre-existing type 2 diabetes mellitus, in pregnancy ....)
• O24.12 (Pre-existing diabetes mellitus, type 2, in childbirth) will become (Pre-existing type 2 diabetes mellitus, in childbirth).
• O24.13 (Pre-existing diabetes mellitus, type 2, in the puerperium) will become (Pre-existing type 2 diabetes mellitus, in the puerperium).

You've also got these new codes from which to choose:

• O24.415 (Gestational diabetes mellitus in pregnancy, controlled by oral hypoglycemic drugs)
• O24.425 (Gestational diabetes mellitus in childbirth, controlled by oral hypoglycemic drugs)
• O24.435 (Gestational diabetes mellitus in puerperium, controlled by oral hypoglycemic drugs).

Also note: The presence of gestational diabetes might change your physical status modifier assignment. For example, you might be justified in reporting P2 (A patient with mild systemic disease) or P3 (A patient with severe systemic disease) instead of P1 (A normal healthy patient). Watch for notes in the operative report or ask your anesthesiologist for details before finalizing the claim.