Ob-Gyn Coding Alert

" ICD-9 has many codes for conditions in a pregnant patient some that complicate pregnancy and others that do not. Choosing the right diagnosis will make the difference in whether your practice is paid for extra visits and tests during or after the antepartum period.
 
The ICD-9 code group 640-648 (complications mainly related to pregnancy) includes problems that arise during a pregnancy (642.4x, mild or unspecified pre-eclampsia) or problems already present in the mother that complicate the pregnancy, such as diabetes (648.0x, diabetes mellitus). When a problem such as one of these is clearly complicating a pregnancy, coding the diagnosis is fairly straightforward. But when problems arise that may or may not impact the health of the mother or fetus or the outcome of the pregnancy, choosing the right code or codes and listing them in the right order becomes more complex.
Related or Unrelated?     
Often, complications arise in a pregnancy that may or may not affect the health of either the mother or the fetus, yet the problem or complication is serious enough to require extra monitoring by the physician. That often means extra tests or office visits, above what most carriers consider normal for a global maternity package. The physician must code the complication before it threatens the pregnancy and regardless of whether it becomes a threat during the antepartum period or labor and delivery.
 
Katie Chaffee, CCS, coding specialist for Franciscan Medical Group in Tacoma, Wash., presents the case of an ob/gyn patient who came in for a regularly scheduled visit as part of her global antepartum care. The physician discovered that she had a very enlarged thyroid gland, although it was not an immediate threat to the pregnancy. In a situation like this" " Chaffee asks "does the physician have to state in the record that the problem is complicating the pregnancy in order to use a code from the 640-648 series?" Specifically the code for an enlarged thyroid during pregnancy is 648.13 (thyroid dysfunction; antepartum condition or complication). But Chaffee wonders if 240.9 (goiter unspecified) the non-ob code for thyroid dysfunction isn't the better choice when submitted with V22.0 (supervision of  normal first pregnancy).
Intention is Key
Obstetric ICD-9 coding rules published by the American Hospital Association's Coding Clinic in the fourth quarter of 1993 state that the pregnancy code supercedes all other codes but only if the condition being reported is complicating the pregnancy. So if Chaffee's physician records that the condition is complicating the pregnancy the practice will probably not be able to bill the visit outside of the global package unless at the end of the pregnancy [...]