Ob-Gyn Coding Alert

If the gestational diabetes is treated with both diet and insulin, code this.

Gestational diabetes can often go undetected well into the pregnancy. Patients new to diabetes require significant counseling and education to establish a controlling regimen of care throughout the pregnancy.

Currently, for gestational diabetes, you should use 648.8x (Other current conditions in the mother classifiable elsewhere, but complicating pregnancy, childbirth or the puerperium; abnormal glucose tolerance; gestational diabetes) and choose the fifth digit (0-4) to indicate when the condition or complication occurred. This will be your primary code.

Example: If your ob-gyn saw a 20-week ob patient who was not diabetic before her pregnancy and she is now an insulin-dependent gestational diabetic, you should code her as 648.83 (Abnormal glucose tolerance; antepartum condition or complication). Include V58.67 (Long-term [current] use of insulin) as a secondary code as the physician is treating the gestational diabetes with insulin.

In ICD-10, you'll have specific gestational diabetes codes in category O24.4-- (Gestational diabetes mellitus). These codes are:

• O24.410, Gestational diabetes mellitus in pregnancy, diet controlled
• O24.414, ... insulin controlled
• O24.419, ... unspecified control
• O24.420, Gestational diabetes mellitus in childbirth, diet controlled
• O24.424, ... insulin controlled
• O24.429, ... unspecified control
• O24.430, Gestational diabetes mellitus in the puerperium, diet controlled
• O24.434, ... insulin controlled
• O24.439, ... unspecified control.

In the example above, you would report O24.414.

Documentation: The physician must document if the gestational diabetes occurs in pregnancy, childbirth, or the puerperium. He should also document how he treats the gestational diabetes--with diet or insulin.

Use these codes for "diabetes mellitus arising in pregnancy" or "gestational diabetes mellitus NOS."

Here is how you will find these codes in the Alphabetic Index:

- complicated

- - by

- - - diabetes

- - - - gestational O24.429

- - - - - diet controlled O24.420

- - - - - insulin controlled O24.424

- - - gestational diabetes O24.429

- - - - diet controlled O24.420

- - - - insulin (and diet) controlled O24.424

- gestational (in pregnancy) O24.419

- - diet controlled O24.410

- - in childbirth O24.429

- - - diet controlled O24.420

- - - insulin (and diet) controlled O24.424

- - insulin (and diet) controlled O24.414

- - puerperal O24.439

- - - diet controlled O24.430

- - - insulin (and diet) controlled O24.434

- gestational diabetes O24.439

- - diet controlled O24.430

-- insulin (and diet) controlled O24.434

Coder Tips: If the physician is treating the gestational diabetes patient with both diet and insulin, then you should only report the insulin-controlled code.

You should not code Z79.4 (Long-term [current] use of insulin).

You should report an abnormal glucose tolerance test in pregnancy with a code from category O99.81 (Abnormal glucose complicating pregnancy, childbirth, and the puerperium) if the provider has not documented gestational diabetes.