Ob-Gyn Coding Alert

Question: Patient has chronic hypertension (CHTN) with proteinuria. Blood pressure is stable without medication, proteinuria 24hr 344mg-->1012g. Normal pregnancy-induced hypertension (PIH) labs. The patient remains asymptomatic at this time. Normal renal ultrasound (U/S). Does this mean I should report 642.4x for a patient with CHTN with proteinuria?

Answer: No, you should not report 642.2x (Other pre-existing hypertension complicating pregnancy, childbirth, and the puerperium).

The real question is whether she has gestational or pre-existing hypertension. With increased protein, you should code 642.4x (Mild or unspecified pre-eclampsia) if she has elevated protein with gestational hypertension. On the other hand, you should report 642.7x (Pre-eclampsia or eclampsia superimposed on pre-existing hypertension) if she has pre-existing hypertension (whether under control or not) with elevated protein.

ICD-10: When your coding system changes in 2013, you'll report the following equivalents:

• 642.4x = O14.Ø2 (Mild to moderate pre-eclampsia, second trimester), O14.Ø3 (Mild to moderate preeclampsia, third trimester), O14.92 (Unspecified preeclampsia, second trimester), or O14.93 (Unspecified preeclampsia, third trimester)
• 642.7x = O11.1 (Pre-existing hypertension with pre-eclampsia, first trimester), O11.2 (Pre-existing hypertension with pre-eclampsia, second trimester), or O11.3 (Pre-existing hypertension with pre-eclampsia, third trimester).