ICD 10 Coding Alert

Don’t include BMI diagnoses for pregnant patients.

You learned the new ICD-10-CM codes that premiered Oct. 1, 2018 — but you need to know more than just the codes. Check out these two ICD-10 guideline revisions to avoid mistakes.

Incorporate These Drug Use During Pregnancy Updates

The first revision deals with “Chapter 15: L. 3) Drug use during pregnancy, childbirth and the puerperium.”

The revised guideline states: “Codes under subcategory O99.32- (Drug use complicating pregnancy, childbirth, and the puerperium) should be assigned for any pregnancy case when a mother uses drugs during the pregnancy or postpartum. This can involve illegal drugs, or inappropriate use or abuse of prescription drugs.”

Example: Your ob-gyn discovers a pregnant patient in her second third trimester is continuing an opioid abuse after performing a drug test due to her history. You would report O99.323 (Drug use complicating pregnancy, second trimester).

Also, the guidelines go on to say: “Secondary code(s) from categories F11-F16 and F18-F19 should also be assigned to identify manifestations of the drug use.” So, in the example, you would report F11.1 (Opioid abuse) in addition to O99.323.

Note that the codes for opioid use differentiate between abuse (the patient takes drugs to feel good) and dependence (the patient’s body cannot function without the drugs and she will have withdrawal symptoms if they are withheld).

Important: In general, the ob-gyn will discover drug abuse or dependence via a history provided by the patient, but often patients will not self-report drug use for fear of legal issues. Many states have established laws that mandate reporting drug abuse or dependence/addiction during pregnancy, so each provider must be well informed about these laws.

The Guttmacher Institute has published a summary of State policies in this regard, and you can access this document at: www.guttmacher.org/state-policy/explore/substance-use-during-pregnancy.

Know the Changes to BMI Inclusion

Your next ICD-10 guideline revision focuses on “Chapter 21 C. 3) Z68 Body mass index (BMI).” The revised sections added are in bold below:

“BMI  codes should  only be assigned when the associated diagnosis  (such as overweight or obesity)  meets the definition of a reportable diagnosis (see Section III, Reporting Additional Diagnoses). Do not assign BMI codes during pregnancy.  See  Section  I.B.14  for  BMI  documentation  by  clinicians  other  than  the  patient’s  provider.”

In other words, you should not include a BMI code when your ob-gyn is seeing a pregnant patient. “This rule makes a lot of sense,” says Melanie  Witt,  RN,  MA, an independent ob-gyn coding consultant in Guadalupita, New Mexico. “As pregnant patients gain weight during pregnancy, recording BMI would not be accurate on the date of service since the weight used to calculate the BMI would include the weight of the fetus.”