Ob-Gyn Coding Alert

PMDD Tops List of Ob-Gyn ICD-9 Changes for Fall

With four significant changes and dozens of minor alterations, the new ICD-9 codes, effective Oct. 1, will affect reporting for peripartum cardiomyopathy, pelvic adhesions and contraception, among others.

When looking strictly at the Genitourinary System and Pregnancy, Childbirth, and Puerperium ICD-9 code revisions and additions, there are exactly four. The new ICD-9 will include the term "premenstrual dysphoric disorder (PMDD)" in 625.4 (Premenstrual tension syndromes), and PMDD will be directly referenced in the alphabetic index. This clearly indicates that PMS and PMDD are related conditions and would be coded the same.

Ob Changes Are on the Horizon
For obstetric changes beginning Oct. 1, ICD-9 adds a new code for peripartum cardiomyopathy, 674.5x. This condition refers to cardiac failure caused by heart muscle disease in the period before, during or after delivery. As with all obstetric chapter codes, this one will require a fifth digit of 0 (unspecified as to episode of care or not applicable), 1 (delivered, with or without mention of antepartum condition), 2 (delivered, with mention of postpartum complication), 3 (antepartum condition or complication), or 4 (postpartum condition or complication). The inclusion term listed with the code refers to postpartum cardiomyopathy, but you may use this code when the patient has this condition during the antepartum period as well. Note that you formerly would reference postpartum cardiomyopathy with 674.8x. So you may have to revise practice encounter forms to capture the new diagnosis.

And for those coders who were wondering which ICD-9 code to assign to a pregnant patient with pelvic peritoneal adhesions, the alphabetic index will specifically reference 648.9x (Other current conditions in the mother classifiable elsewhere, but complicating pregnancy, childbirth, or the puerperium).

Finally, ICD-9 adds two codes that will alleviate several coding headaches. The first new code removes decreased libido from the mental-health chapter. You will be able to assign 799.81 for visits associated with complaints of decreased libido or sexual desire. The second new code, V25.03, is for encounters for emergency or postcoital contraception or counseling. "The V25.03 code has been long awaited and will be perfect for those 'morning after' pill situations," says Jaime Darling, CPC, a certified coder with Graybill Medical Group in Southern California.

Other miscellaneous code additions and revisions that may interest ob-gyn practices include:

Severe acute respiratory syndrome (SARS) reporting. Beginning in October,
you should report 079.82 for SARS-associated coronavirus, use 480.3 for pneumonia due to SARS-associated coronavirus, and submit V01.82 if the patient is exposed to SARS-associated coronavirus. If a pregnant patient is exposed to SARS and is being monitored for the condition, the codes would be V22.2 (Pregnant state, incidental), plus V01.82. If the physician tests the patient for the SARS virus, [...]