Diagnosis Codes for Inflammatory Disease of Female Pelvic Organs
Published on Thu Oct 01, 1998
When the physician writes pelvic inflammatory disease (PID) in the diagnosis section of the patient chart should you automatically choose the unspecific code 614.9 for inflammatory disease of the pelvic organs and tissues (PID)? Not without careful consideration, says Linda Dominguez, RN-C, a womens health nurse practitioner from Albuquerque, NM. Something might be called PID based on what the findings suggest, but PID cant be definitively diagnosed without doing a laparoscopy. Thats why there isnt a specific code for PID. A further understanding of this disease and how the codes for Inflammatory Disease of the Female can assist the ob/gyn coder in correct coding and avoiding rejections.
Dos and Donts of Diagnosis Coding for PID
The section in the ICD-9 that covers inflammatory diseases of the female pelvic organs is 614-616. It contains a number of very specific codes that includes inflammatory diseases of the ovary, fallopian tubes, pelvic cellular tissue and peritoneum. Mixed in among the specific codes are some nonspecific codes such as 614.9 (unspecified inflammatory disease of female pelvic organs). The specific codes not only identify the inflammatory diagnosis, they are specific as to exact location. In addition, the codes are further divided into acute or chronic. Acute codes should be used when the onset has been sudden and severe. Chronic codes should be used when coding a problem that has been persistent and lingering.
Whether the codes in this section are specific or nonspecific, it is important to note that all of them are used to report a confirmed inflammatory process. The only time we use these specific codes, says Lisa A. Lorence, medical billing specialist with the ob/gyn section of the Toledo Clinic, is when the patient has come back from surgery, or the doctor has specifically indicated a confirmed diagnosis. There are no codes in this section for suspected or rule-out pelvic inflammatory processes.
I wouldnt use the nonspecific codes, Lorence says. Instead, she says that if she saw a diagnosis of just PID, without any indication in the chart of how it was confirmed, she would go ask the caregiver questions to help code more specifically. Betty Ruppersberger, billing manager for Center for Womens Health in Langhorne, PA agrees. I usually ask the physician, she adds. Both Lorence and Ruppersberger echoed one of the cardinal rules of diagnosis coding, that one should always code the symptoms if you do not have a confirmation of the disease. Start with what the patient came to the office for, explains Lorence, and then use the PID code (614.9) as a secondary diagnosis. Ruppersberger says one of the most common symptoms is abdominal or pelvic pain, so she would code the pain as the primary diagnosis and then follow [...]
