Wiki Abortions- Elective and Therapeutic dx codes

[dbolivar1]

Hello,

The following questions, I haven't been able to find an answer. Hope I can get some help.

1) When using Z33.2 Elective termination and patient is anemic do we continue to use "O" codes (O99.01 and D64.9)?

2)What if the patient decided to have an abortion because fetus has Trisonomy-21. Do we use only O35.13X0? Or do we use Z33.2 along with it. Or O35.13X0 with Z3A.?

3) Don't quite remember where I read this but can we use Z64.0- Problems related to unwanted pregnancy instead of Z33.2? Or in what cases can we use that?

Thank you in advance!

 

[Cmama12]

Hi, as far as #2 goes, I would not use Z33.2, only the condition and wks of gestation. #3 - Z64 codes fall under social determinants of health, and are just additional info, so I would not use that as a primary dx. And #1 - since you are not supposed to use a wks of gest code with Z33.2, then it follows that you would not also use an O code because then you would need to add wks of gestation. O codes also have sequencing priority, so they would come first, so again doesn't work with Z33.2.

 

[natashalage]

Hello, I tried to attach the photo-shot from 3M that I found a year ago and kept in my folder on How to code elective abortion when fetus has abnormality; but i could attach it. 3M under Coding of Pregnancy and Childbirth complications, Abortions.. Chapter 24 Abortion and Ectopic pregnancy says:
A patient who had rubella at 6 weeks request abortion because of the possibility of fetal abnormality. Code Z33.2 Encounter for elective termination of Pr. is designated as the principal diagnosis with code O35.3xx0 Maternal care for suspected damage to fetus..- as a secondary dx.
A patient who is 26w presents for elective termination of pr due to fetal anomalies. Assign code Z33.2 as the principal dx. Code O35.9xx0 for fetal abnormality and damage- as an additional dx.
I started using this guidance.

 

[Cmama12]

Hello, I tried to attach the photo-shot from 3M that I found a year ago and kept in my folder on How to code elective abortion when fetus has abnormality; but i could attach it. 3M under Coding of Pregnancy and Childbirth complications, Abortions.. Chapter 24 Abortion and Ectopic pregnancy says:
A patient who had rubella at 6 weeks request abortion because of the possibility of fetal abnormality. Code Z33.2 Encounter for elective termination of Pr. is designated as the principal diagnosis with code O35.3xx0 Maternal care for suspected damage to fetus..- as a secondary dx.
A patient who is 26w presents for elective termination of pr due to fetal anomalies. Assign code Z33.2 as the principal dx. Code O35.9xx0 for fetal abnormality and damage- as an additional dx.
I started using this guidance.

Hi, the term "elective" is not the same as "therapeutic". An elective abortion is an abortion because you don't wish to continue the pregnancy for whatever reason. A therapeutic abortion is when your health or the health of the fetus are in question and the pregnancy is terminated for health reasons. Here is an excerpt from Cigna's policy, for example - For the purpose of this Administrative Policy an elective abortion is the termination of pregnancy at the discretion of the woman for reasons other than maternal health or fetal disease. Elective abortion is reflected when ICD-10- CM code Z33.2 (Encounter for elective termination of pregnancy) is either billed alone or with Z32.01 (Encounter for pregnancy test, result positive).

 

[nielynco]

Hello,

The following questions, I haven't been able to find an answer. Hope I can get some help.

1) When using Z33.2 Elective termination and patient is anemic do we continue to use "O" codes (O99.01 and D64.9)?

2)What if the patient decided to have an abortion because fetus has Trisonomy-21. Do we use only O35.13X0? Or do we use Z33.2 along with it. Or O35.13X0 with Z3A.?

3) Don't quite remember where I read this but can we use Z64.0- Problems related to unwanted pregnancy instead of Z33.2? Or in what cases can we use that?

Thank you in advance!

This is an excellent question and one that has never been adequately addressed by the ICD10 guidelines. In order to get a definitive answer to this type of question you submit it to the AHA Coding Clinic (https://www.codingclinicadvisor.com). If you are a first time user you simply register. I would do this for you, but they require actual medical documentation that illustrates the question being asked and will not respond to general coding questions without it. So if you have the documentation note for #1 & 2 then submit it and directly ask them whether it is okay to use just the O codes for the fetal complication rather than appending the code for elective termination of pregnancy when the procedure is performed. Then please share with us their reply. The guidelines only deal with an elective abortion and as we know the tinkering with semantics (in the past the ICD committee had taken the stance that abortions only needed to be classified as elective, failed, missed, incomplete or complete and the idea of "therapeutic" did not come into play) has led to a need to clarify. I personally think there should be a separate code for this, as this allows you to track the severity of the problems with women who elect to terminate whatever the cause, but using only a maternal or fetal complication code alone should certainly paint the same picture, but would not per se collect data related to the reasons for abortion if researchers are not using both CPT and ICD10 code to collect such data. Ah well, when I get to be queen of the coding world....