Ob-Gyn Coding Alert

Question: A pregnant patient came in through the emergency department ED for right lower quadrant (RLQ) pain. We admitted her, and she was found to have appendicitis. General surgery took her to the OR. We continued to follow her post operatively daily to make sure she was not going into preterm labor (PTL). Any suggestions on what diagnosis to use? I was thinking 646.83 and then something else? I don’t think we should use appendicitis as that is not why we are following her. We want to make sure the baby is OK and again, that she does not go into PTL. She is 28 weeks if that makes a difference. What should I report?

California Subscriber

Answer: Yes, you should go with 646.83 (Other specified antepartum complications) but also add V15.29 (Personal history of surgery to other organs).

ICD-10: When your diagnosis system changes, you will not find an “other” code that replaces 646.8x, and the only code that mentions surgery on the mother infers there was a uterine scar during that surgery or that there was suspected damage to the fetus due to an “in utero” procedure on the fetus. The ICD Coordination and Maintenance Committee has been contacted regarding this oversight, but the earliest a change can be made now is a full year after the implementation of ICD-10-CM. The best code to use for this additional supervision would be one of the following codes:

• O09.891, Supervision of other high risk pregnancies, first trimester
  
• O09.892, Supervision of other high risk pregnancies, second trimester
  
• O09.893, Supervision of other high risk pregnancies, third trimester
  
• O09.899, Supervision of other high risk pregnancies, unspecified trimester.
  

The secondary code would be Z98.89 (Other specified postprocedural states).