Revenue Cycle Insider

Question: Payers are denying prior authorizations for our pregnant patients who are experiencing back pain, hip pain, etc. and want to seek treatment with physical therapy. Do we have to report the ICD-10-CM Chapter 15 “O” code when the therapist isn’t treating the pregnancy but rather the condition of back pain or hip pain? Is there anything the therapist needs to document? This is a relatively new problem, but it is becoming more widespread.

Wisconsin Subscriber

Answer: Coding rules for obstetrics indicate that any condition present during pregnancy is related to the pregnancy unless the physician states otherwise. So, if your ob-gyn ordered physical therapy for a reason other than the pregnancy, you wouldn’t code from the “O” section. However, you will want to be prepared to appeal with documentation, since back and hip pain are generally inherent to pregnancy.

Note: If the pain is related to an injury or pre-pregnancy condition, it’s going to be important that this has previously been documented. Otherwise, the payer is going to deny the service and bundle it into the antepartum care.

Suzanne Burmeister, BA, MPhil, Medical Writer and Editor