Ob-Gyn Coding Alert

Question: I have a patient who wants to schedule a primary cesarean section. Indication is previous forceps delivery. Would the ICD-9 be 669.50, or can I use V23.9?


Florida Subscriber


Answer: No. If you report 669.50 (Forceps or vacuum extractor delivery without mention of indication; unspecified as to episode of care or not applicable), you're telling the payer that there was a complication during this episode of delivery.

Instead, you have two options:
  Use 669.71 (Cesarean delivery, without mention of indication; delivered, with or without mention of antepartum condition), or
  Assign a diagnosis for patient anxiety (648.41, Mental disorders; delivered, with or without mention of antepartum condition). Code V23.9 (Unspecified high-risk pregnancy) will probably not fly for a delivery code because the code category is "supervision" of high-risk pregnancy.

Anxiety due to the previous use of forceps (in the absence of any additional information on this pregnancy such as overly large fetus) does not put her in a high-risk category for this pregnancy.