Radiology Coding Alert

Question: I’ve been told that there is a new guideline on reporting for patients who are using drugs or prescription pills during pregnancy. How would you code a pregnant patient at 24 weeks that is actively using marijuana?

Colorado Subscriber

Answer: Previously, the ICD-10-CM guidelines only instructed coders on how to report patient encounters for tobacco use and alcohol use during pregnancy. Included in the 2019 guidelines is a set of instructions on how to report “drug use during pregnancy, childbirth and the puerperium.” In Chapter 15 of Section 1.C of the ICD-10-CM, the new set of guidelines state the following:

• “Codes under subcategory O99.32-, Drug use compli­cating pregnancy, childbirth, and the puerperium, should be assigned for any pregnancy case when a mother uses drugs during the pregnancy or postpartum. This can involve illegal drugs, or inappropriate use » or abuse of prescription drugs. Secondary code(s) from categories F11-F16 and F18- F19 should also be assigned to identify manifestations of the drug use.”

This guideline instructs you report a code from category O99.32- (Drug use complicating pregnancy, childbirth, and the puerperium) during any instance where a patient encounter involves pregnancy with illicit substance use. For any manifestations of the drug use, you should report a code from one of the F categories listed above.

The question regarding marijuana use during pregnancy becomes problematic due to the varying legality of marijuana use from state-to-state. In order to determine whether marijuana is applicable to this new guideline, you must have a proper understanding of what constitutes a “drug.” According to Stedman’s Medical Dictionary, a drug is a “general term for any substance, stimulating or depressing, that can be habituating or addictive, especially a narcotic.” Similarly, marijuana remains a schedule 1 narcotic under federal law. Therefore, you should classify marijuana as a drug, and code accordingly, when you encounter a patient actively using during pregnancy.