Ob-Gyn Coding Alert

Question: We need to send a patient out for a fetal echocardiogram because her first child has a congenital heart defect. What diagnosis code should we use?

Florida Subscriber

Answer: The correct code would be V23.49 (Pregnancy with other poor obstetric history) because the physician has not confirmed that the fetus has a problem, but the last pregnancy did have a problem. Consequently, the ob-gyn is supervising a pregnant patient with a poor obstetric history.

You should not use 746.9 (Unspecified anomaly of heart) because the ICD-9 guidelines instruct that you can assign a code from the congenital abnormalities chapter (740-759) only when the physician diagnoses the condition for an infant (that is, after birth).

If the echocardiogram confirms the condition, the diagnosis becomes 655.83 (Other known or suspected fetal abnormality, not elsewhere classified; antepartum condition or complication) for all future encounters (assuming that the ob-gyn does not know this diagnosis when he or she orders the echocardiogram or he or she does not make this diagnosis after performing the procedure in the office).