Ob-Gyn Coding Alert

Make sure you heed the advice featured in the Note under this code set. 

When a patient is pregnant, she undergoes important alterations in acid-based, electrolyte, and renal function due to pregnancy-associated physiologic changes in renal and systemic hemodynamics. That means she might be susceptible to conditions such as albuminuria, nephropathy, uremia, and gestational proteinuria.

ICD-9-CM Codes: Currently, you would report this condition with the following codes:

• 646.20, Unspecified renal disease in pregnancy without mention of hypertension unspecified as to episode of care
• 646.21, Unspecified renal disease in pregnancy without mention of hypertension with delivery
• 646.22, Unspecified renal disease in pregnancy without mention of hypertension with delivery with postpartum complication
• 646.24, Unspecified postpartum renal disease without mention of hypertension

ICD-10-CM Codes: In ICD-10, you’ll have specific codes:

• O26.831, Pregnancy related renal disease, first trimester
• O26.832, Pregnancy related renal disease, second trimester
• O26.833, Pregnancy related renal disease, third trimester
• O26.839, Pregnancy related renal disease, unspecified trimester

ICD-10-CM Change: Currently, you have four codes specifying renal disease during pregnancy. You base these on the episode of care, as in delivery or delivery with postpartum complication. Once the ICD-10 implementation date rolls around, you will report your pregnancy related renal disease based on the first, second, third, or unspecified trimester.

Documentation: You need to report the specific disorder, but you will look to these codes when your provider documents any of the following conditions and there is no evidence of hypertension:

• Albuminuria in pregnancy or the puerperium
• Nephropathy NOS in pregnancy or the puerperium
• Renal disease NOS in pregnancy or the puerperium
• Uremia in pregnancy or the puerperium
• Gestational proteinuria in pregnancy or the puerperium

Here’s how you will locate these codes in the Alphabetic Index:

Nephropathy (see also Nephritis) N28.9

- pregnancy-related O26.83-

Pregnancy (single) (uterine)—see also Delivery and Puerperal

- complicated by (care of) (management affected by)
- - glomerular diseases (conditions in N00-N07) O26.83-
- - nephropathy NEC O26.83-
- - renal disease or failure NEC O26.83-

Coder tips: You will see a Note underneath O26.83 (Pregnancy related renal disease) stating that you need to use an additional code to identify the specific disorder. For instance, the patient may have a form of renal disease that is caused by Lupus, so you would report M32.14 (Glomerular disease in systemic lupus erythematosus) as your secondary diagnosis.