Ob-Gyn Coding Alert

Question: My ob-gyn is seeing a pregnant patient who is age 56. I know she is considered high risk, so I tried to use the V23.8 series. Our payer denied the claim because the diagnosis code specifies age 12-55. What ICD-9 code should I use instead? Should I report a normal pregnancy diagnosis?

California Subscriber

Answer: Under ICD-9 rules, you have no age cut-off. Therefore, V23.81 (Elderly primigravida) or V23.82 (Elderly multigravida) is the correct code. If you reported only V23.8 instead, your payer would deny your claim because you have not listed the most specific code that relates to the patient's age and her pregnancies.

If you used one of these fifth-digit codes and the payer still denied the claim, you need to contact the payer and let them know that this is an unusual circumstance --the patient is actually 56 and is pregnant despite that. If the insurer has a problem with the correct V code, the same problem would occur if you instead used 659.5x (Elderly primigravida).

The patient's age is complicating the pregnancy's management. The insurer needs to correct this; you should not change your coding.