Ob-Gyn Coding Alert

Question: Which diagnosis code should I use for a woman with a history of stillborns and suspected trisomy?

Georgia Subscriber Answer: If the ob-gyn suspects that the patient is carrying a trisomy fetus because of abnormal test results, report 796.5 (Abnormal finding on antenatal screening) along with V23.49 (Pregnancy with other poor obstetric history) for the history of stillborns. If the physician conducts tests to determine if the fetus is trisomic, given the patient's history, then you could submit 655.13 (Known or suspected chromosomal abnormality in fetus; antepartum condition or complication) along with V23.49 (in this case, V23.49 would appear first on the CMS-1500 form).
 
You should report a code from the 655 or 656 categories only when the suspected or known fetal condition alters the management of the mother (such as performing diagnostic tests or providing additional observation), according to ICD-9 guidelines. The fact that the fetal condition exists or is suspected to exist does not justify using one of these codes (see ICD-9 guidelines, C11, C. Fetal Conditions Affecting the Management of the Mother).