Ob-Gyn Coding Alert

Question: Under what circumstance should I use the diagnosis code V72.40?


California Subscriber


Answer: You can only use the new code V72.40 (Pregnancy examination or test, pregnancy unconfirmed) when, at the end of the visit, the ob-gyn has not confirmed that the patient is pregnant.

For example, if the ob-gyn draws a blood specimen and orders a serum HCG to confirm pregnancy, you would not have the results back at the end of the visit.
 
If the ob-gyn performs a urine color test with a positive result, then according to the official ICD-9 guidelines your diagnosis would be V22.0 (Supervision of normal first pregnancy) or V22.1 (Supervision of other normal pregnancy), because you must code what you know at the end of the visit. This is true unless the ob-gyn does not find a problem, in which case you should report the symptoms or complaints.

There has been discussion of this issue over the years, because many payers will try to include the pregnancy diagnosis visit as part of the global care, if you use the V codes. However, the ICD-9 guidelines are very clear on this point. The American College of Obstetrics and Gynecology has recommended that if you are in this situation, you should use 626.8 (Missed period) for the primary diagnosis on the E/M code. But it would probably also be wise to use V22.0 or V22.1 on the urine lab test that confirmed pregnancy.