Wiki Anyone knowledgable about Observation coding?

[philgro]

Just got a new job! I'd thought I'd be mostly doing outpatient encounters at an ASU, but it turns out a large part of my responsibilty is observations, which are almost all maternity related.
Nearly all of the reasons for visits are either "rule outs"- rule out PIH, rule out preterm labor, etc., or they are simply orders for Non Stress Tests. It is very rare for any of these to have an actual diagnosis given in the physician's notes, or even to be able to infer something definite.

For admitting and reason for visit Dx, it sometimes seems appropriate to code for the suspected condition, but I'm often at a loss of how to code the Principal Diagnosis.
I've often had to settle on V8909 "other suspected maternal or fetal condition not found"
or 64683 "other specified complication of pregnancy"

Anyone have any input on these types of situations?
Thanks!
Phil

 

[mitchellde]

I agree with Mdunn. The V89.xx codes are for conditions suspected but not found after study.. think of these codes as "ruled out" codes. There is no code and no way to code for suspected or rule out conditions

 

[LindaEV]

When there is a rule out situation, you can usually code from te symptons...pain or bleeding...there has to be a reason they are worried about pre-term labor, or whatever.

 

[Scatlot]

V8909

I recently starting coding OB patients that are sent to for NST, observation, etc. Most have vague symptoms. V89.0 codes seem to be a great way to code these, but the Coding Clinic states these are to be used in very limited circumstances, which confuses me since it seems the majority of these OB patients, after observation, don't have any problems.

How would you code the following: An OB patient came in suspecting her water had broke because her clothes were wet. She had no other symptoms. Observation and NST were performed. It was determined that she was not in labor, her water had not broken, and no contractions were detected. However the patient does have gestational diabetes. Is it appropriate to use V89.09 in this case? The gestational DM is not related to her water breaking, but it is related to the pregnancy. After talking with my coworkers, we decided on V89.09 and 64883. I would be interested to know other's opinions regarding this.