Ob-Gyn Coding Alert

Oct. 1 is the starting line for new codes--are you ready?

The largest update to the ICD-9 codes is the addition of a new section (649) dealing with complications of pregnancy, childbirth or the puerperium. Because ICD-9 gives you no grace period, you-ve got to make these changes right now.

Explain Extra Ob Visits With 649

ICD-9 2007's new category on pregnancy complications (649) will be invaluable to your practice. Carriers are increasingly demanding codes that describe specifically why a pregnancy needed more visits (99212-99215, Office or other outpatient visit for the evaluation and management of an established patient -) and more care, says Marcella Bucknam, CPC, CCS-P, CPC-H, CCA, coding manager for the University of Washington's physician group in Seattle.

Many of these codes deal with complications from obesity (649.10-649.14, Obesity complicating pregnancy, childbirth, or the puerperium ...) or bariatric surgery status (649.20-649.24, Bariatric surgery status complicating pregnancy, childbirth, or the puerperium ...). This reflects medical advances, says Suzan Hvizdash, BSJ, CPC, medical auditor for University of Pittsburgh Physicians. Many women who couldn't become pregnant because of obesity can now become pregnant, thanks to either bariatric surgery or improved fertility treatments.

Important: Codes in category 649 apply to more than just additional encounters for pregnancy complications. You can also use all but one of the codes for problems during childbirth and the puerperium. The 35 new codes will allow you to indicate complications due to:

- tobacco use disorder--649.0x
- obesity--649.1x
- bariatric surgery status--649.2x
- coagulation defects--649.3x
- epilepsy--649.4x
- spotting--649.5x (the fifth digit for this code is 0, 1 or 3 only)
- uterine size-date discrepancy--649.6x. Before Oct. 1, you coded this using 646.8x.

Bonus: Check out the new V code for bariatric surgery: V45.86 (Bariatric surgery status). You should use this when the patient has had this surgery and it is impacting the current care of the patient, says Melanie Witt, RN, CPC-OGS, MA, an ob-gyn coding expert based in Guadalupita, N.M.

Learn New Codes for Inflammatory Disease

Before you use 616.8 (Other specified inflammatory diseases of cervix, vagina, and vulva), you need to know that this code is deleted. In its place, you should report 616.81 (Mucositis [ulcerative] of cervix, vagina, and vulva) or 616.89 (Other inflammatory disease of cervix, vagina and vulva).

Mucositis occurs mainly due to treatment for ovarian cancer by radiation therapy or due to immunosuppressive agents caused by ulceration. Your ob-gyn would not perform a procedure to treat it, Witt says.

For example: Because mucositis predominately occurs due to radiation or chemotherapy, you would use 616.81 as the diagnosis that supports an E/M service for this complication. You-ll also need an E code to explain the adverse effects of therapy (such as E879.2, Radiation therapy).

Bonus: You also have a new code for cervical stump prolapse (618.84). The American College of Obstetricians and Gynecologists (ACOG) requested this code because coders would incorrectly reference this condition with 618.1 (Uterine prolapse without mention of vaginal wall prolapse). Because this condition can occur only when the uterus is no longer present, ICD-9 added this new code for 2007, Witt says.

Index Changes Can Slip You Up

Don't miss: This year, ICD-9 2007 changes the reference for vaginal intraepithelial neoplasia (VIN I and VIN II) from 624.8 (Other specified noninflammatory disorders of vulva and perineum) to 624.0 (Dystrophy of vulva).

Update FGM, Female Genital Organ Disorders

ICD-9 2007 adds a new code to the subcategory for female genital mutilation (FGM) status--629.29, Other female genital mutilation status. You will use this code as a primary diagnosis for the nonpregnant patient who seeks treatment to correct the mutilation or as a secondary diagnosis when a patient who is pregnant underwent this procedure. The physician would indicate that the patient had Type IV mutilation, which means various types of cutting of the genitals, such as tearing the vagina or pricking the clitoris with needles.

Update: ICD-9 2007 strikes out 629.8 (Other specified disorders of the female genital organs), so you should no longer use this code after Oct. 1. You should replace this code with:

- 629.81--Habitual aborter without current pregnancy
- 629.89--Other specified disorders of female genital organs.