Neurosurgery Coding Alert

Question We are currently working for a neurosurgeon who saw a patient for consultation for her OB. The patient is currently pregnant with a history of a ruptured brain aneurysm in 2010 and currently has metallic coil. Patient was requesting her OB to do a vaginal delivery and our surgeon advised against the vaginal delivery due to her history.

Would it be correct to bill the insurance with the ICD code V22.0? Our provider consulted the patient for the history of the brain aneurysm and pregnancy becomes secondary. How do we report the history of brain aneurysm?

New York Subscriber

Answer Code V22.0 (Normal pregnancy) means the physician is supervising a normal pregnancy. In this case she has a history of an aneurysm which is complicating the management of the pregnancy. As she is pregnant, the primary diagnosis should be one from the OB complications chapter unless the physician has documented that this condition is incidental to pregnancy which is obviously not the case here. But since your physician is not an OB, the payer will reimburse for the consult separately before delivery even though you use an OB complication code. She has a high risk pregnancy with this history, but the neurosurgeon is not supervising this high risk pregnancy, so none of the V23 codes would apply.

So instead, you should report 648.93 (Other current conditions classifiable elsewhere of mother antepartum), V12.59 (Personal history of other diseases of circulatory system not elsewhere classified). You would not report 674.03 (Antepartum cerebrovascular disorders) because she does not currently have an aneurysm. The fifth digit of 3 is required because she is in the antepartum period.