Ob-Gyn Coding Alert

Rh incompatibility can occur when the mother is Rh negative and the baby is Rh positive. Testing for Rh factor should take place early in the pregnancy; when an incompatibility is possible, the pregnancy will require careful monitoring. Testing for incompatibility is generally coded by a laboratory. If the office is billing on behalf of the laboratory, the laboratory code would be billed using a -90 modifier (reference [outside] laboratory) to indicate that the test was performed elsewhere. If testing is provided to detect the presence of an Rh incompatibility, the correct diagnosis would be V28.5 (screening for isoimmunization). When Rh incompatibility is noted, the administration of Rh-immune globulin (trade name RhoGAM) to the mother is generally called for.

CPT and HCPCS Coding

Revisions made in the 1999 CPT book have now changed how your practice will bill for RhoGAM injections. There are now two coding options for the injection. New codes were added to CPT for immunoglobulin products. CPT instructs coders to also report the code 90782 (therapeutic or diagnostic injection) for the injection procedure. This code describes the injection only, not the actual provision of RhoGAM. The new CPT code for this product is 90384 (Rho [D] immunoglobulin [RhIG], human, full-dose, for intramuscular use). Medicare requires that the HCPCS code J2790 (injection, Rho (D) immune globulin, human, one dose package) be reported instead. Some payers will require the HCPCS code instead of the CPT code, so be sure to check with your payers to be sure to avoid payment delays.

ICD-9 Codes for RhoGAM Injections

When submitting claims for RhoGAM injections, be sure to use either ICD-9 code 656.1X (rhesus isoimmunization) if the patient has this problem or V07.2 (prophylactic immunotherapy) if the RhoGAM is being given prophylactically to substantiate the need for the injection. The fifth digit (0, 1, 3) further specifies the episode of care. The 0 indicates unspecified as to episode of care or not applicable; 1 is delivered, with or without mention of antepartum condition; and 3 is antepartum condition or complication.

Note: It is important to note that this code is assigned to the claim for the mother (the ob patient). If your practice is additionally coding for care provided to the infant born with Rh disease, you may use ICD-9 code 773.0 (hemolytic disease due to Rh isoimmunization).