Ob-Gyn Coding Alert

Here's why you can strike 996.39, 631, and V12.2 from your possible coding options.

ICD-9 2012 adds more specific codes to your ob-gyn coding cache, such as diagnoses reflecting when a patient planning a cesarean section needs a cesarean section early or when her vaginal mesh erodes.

Remember: What makes this ICD-9 2012 update special is this is the last time you'll need to learn and delete ICD-9 codes before the switch to ICD-10 in 2013 unless a code is required to report a new disease. The diagnosis freeze begins October 1st of this year.

Prepare Now For New Pregnancy Options

The following new codes for ICD-9-2012 reflect early spontaneous labor with a planned cesarean delivery:

• 649.81 (Onset [spontaneous] of labor after 37 completed weeks of gestation but before 39 completed weeks gestation, with delivery by [planned] cesarean section, delivered, with or without mention of antepartum condition)
• 649.82 (Onset [spontaneous] of labor after 37 completed weeks of gestation but before 39 completed weeks gestation, with delivery by [planned] cesarean section, delivered, with mention of postpartum complication)

You'll use these codes when a patient was planning on having the cesarean but went into labor early, so had to have the cesarean early, says Melanie Witt, RN, CPC, COBGC, MA, an ob-gyn coding expert based in Guadalupita, N.M.

You'll also have a new diagnosis to demonstrate a chemical or "false" pregnancy after October. Check out 631.0 (Inappropriate change in quantitative human chorionic gonadotropin [hCG] in early pregnancy).

Additionally, if a patient has a blighted ovum or mole, you'll use 631.8 (Other abnormal products of conception).

You Will Delete 996.39 In Lieu Of New Options

As of October 1, you will no longer report 996.39 (Other mechanical complication of genitourinary device, implant, and graft) if the patient has a erosion or exposure of mesh material used during pelvic reconstruction surgery. Instead, you have two more specific options. They are:

• 629.31 (Erosion of implanted vaginal mesh and other prosthetic materials to surrounding organ or tissue); and
• 629.32 (Exposure of implanted vaginal mesh and other prosthetic materials into vagina).

Example: Suppose the ob-gyn noticed the erosion of Prolene mesh to the vaginal cuff from a prior abdominal sacral colpopexy. Then he did surgery to remove this mesh the following week. He used Mayo scissors to trim down all of the mesh and vaginal margins. He closed the vaginal cuff with #0 Vicryl suture from the left vaginal angle and completed it at the right. For this procedure, you would report 57295 (Revision [including removal] of prosthetic vaginal graft; vaginal approach) for revision of a vaginal graft (vaginal approach). After October 1, you would link 629.31 to this code.

Treat New Hemorrhagic Disorder Codes As Secondary Dx

If a pregnant patient has antiphospholipid antibodies, you have two new codes to use as secondary diagnoses. Note: Your primary diagnosis would be from the coagulation defects category (649.3x).

If the patient simply had the antibody as a finding, the secondary code would be existing code 795.79 (Other and unspecified nonspecific immunological findings). If the condition is with a hypercoaguable state (meaning a tendency to form blood clots), the secondary code would be existing code 289.81 (Primary hypercoagulable state). However, if the patient has the antibody and has a current hemorrhagic disorder, you have new code 286.53 (Antiphospholipid antibody with hemorrhagic disorder), Witt says.

ICD9 also added an "other" code to the 286.5x category, which is 286.59 (Other hemorrhagic disorder due to intrinsic circulating anticoagulants, antibodies, or inhibitors).

Finally, More Codes Reflect a Patient's Personal History

You will have more V code options when your ob-gyn documents a patient's personal history. They are:

• V12.21 (Personal history of gestational diabetes);
• V12.29 (Personal history of other endocrine, metabolic, and immunity disorders);
• V23.42 (Pregnancy with history of ectopic pregnancy); and
• V23.87 (Pregnancy with inconclusive fetal viability).

With these changes in mind, the following codes will no longer be valid:

• 631 (Other abnormal product of conception)
• V12.2 (Personal history of endocrine, metabolic, and immunity disorder)

Keep reading the Ob-gyn Coding Alert to prepare for all your 2011 and ICD-10 coding changes!