Ob-Gyn Coding Alert

Question: When is it appropriate to add the O99.32- codes? My physicians are very hesitant to use them. They want to use R82.5 for positive drug screen. I think they do not want the patients to be identified as a drug abuser. What should I do? If I use the O99.32- codes, should they stay on the patient on the length of the pregnancy, or can this be removed when they have a negative drug screen?

Delaware Subscriber

Answer: You would report the O99.32- (Drug use complicating pregnancy, childbirth, and the puerperium…) codes until this issue has been resolved and only the clinician should make this determination.

The rule in ICD-10 is very clear when it comes to use of the OB complication codes. If the condition is complicating the pregnancy (and the physician does not indicate at the time of the visit that the problem is incidental to pregnancy), you MUST use the OB complication code as primary.

You cannot use R82.5 (Elevated urine levels of drugs, medicaments and biological substances) except for drugs such as steroids, catecholamines (epinephrine) or indoleacetic acid (elevated with tumors). If the drug screen is positive for controlled substances, it would be drug use in pregnancy, and O99.32- is the appropriate code. One would hope there are some interventions going on as well so this would be an ongoing issue for the pregnancy and physician intervention. This also means reporting an F11-F16 or F18-F19 code as well for any manifestation (but there are “uncomplicated” manifestation codes for the drug they tested positive for). But also be sensitive to reporting this diagnosis by understanding your State laws pertaining to reporting drug abuse in pregnant patients.