Ob-Gyn Coding Alert

Notice the difference in the definitions; what code you'll use depends on (1) unspecified episode of care, (2) the delivery with or without an antepartum condition, or (3) with an antepartum condition or complication.

In some cases, the mother or the multiple babies (such as triplets) are endangered if she carries all of the babies until delivery. Therefore, the ob-gyn may recommend that one of the fetuses be terminated, says Nadia Noor, CPC, a reimbursement specialist at the Austin Diagnostic Clinic in Texas.

Heads-up: Fetal reduction procedures reduce the risk to the remaining fetuses, but you should still consider the pregnancy high-risk, especially following a fetal reduction procedure, says a coding instructor in Santa Rosa, Calif.

Red flag: Don't confuse these codes for multiple gestation following elective fetal reduction with the existing multiple-gestation codes 651.3x-651.6x.

For now: An ob-gyn sees a patient with a triplet pregnancy and discovers that two of the babies appear normal, but the third has anencephaly, a defect in brain development resulting in small or missing brain hemispheres. The patient decides to have a fetal reduction. The ob-gyn performs this procedure in her second trimester to optimize the survival of the two normal-appearing fetuses. You would report 651.43 (Triplet pregnancy with fetal loss and retention of one or more fetus[es]; antepartum condition or complication).

In the future: After Oct. 1, you should look to 651.40-651.73 for the appropriate code.

If the ob-gyn admits the patient for the termination, you should use the elective abortion code with a category 651 code (Multiple gestation) for the pregnancy count at the time of the reduction. If the ob-gyn admits the patient for a status situation after the fact, you should use 651.7x without the termination code. Keep in mind that you can use 651.7x with any other complication code.

Be Prepared for More Particular Peritonitis Codes

When you get ready to code for peritonitis, you'll find an expanded list of ICD-9 classifications that allow for multiple and varied conditions previously included in 567.2 (Other suppurative peritonitis). In particular, you'll find the following four new codes: 

Notice the fifth digits for the 567.2x codes. They represent the expansion of a four-digit code to a five-digit one. Don't worry about the fifth digits of 2, 8 and 9 - they have no meaning other than the code order.

For now: You should report 567.2 (Peritonitis; other suppurative peritonitis) for a patient who has a presacral abscess. Peritonitis may occur as a consequence of undetected bowel perforations.

In the future: After Oct. 1, you'll be able to report 567.29 (Other suppurative peritonitis).

Note: For a free tabular listing of the new ICD-9 codes likely to impact your ob-gyn practice, e-mail me at suzannel@eliresearch.com.