Wiki Diagnosis codes to use for physical therapy on pregnant patients

[hoierj]

Payers are denying prior authorizations for pregnant patients experiencing back pain, hip pain, etc. that are seeking treatment with physical therapy. Do we have to report the chapter 15 "O" code when the therapist isn't treating the pregnancy but rather the condition of back pain or hip pain. Is there anything the therapist needs to document?
This is a relatively new problem but it becoming more widespread.

 

[Pam Warren]

Coding rules for obstetrics indicate that any condition present during pregnancy is related to the pregnancy unless the physician states otherwise. So if he's ordered PT for a reason other than the pregnancy, you wouldn't code from the O section, but be prepared to appeal with documentation, since back and hip pain are generally inherent to pregnancy. If related to an injury or pre-pregnancy condition, it's going to be important that this has previously been documented, otherwise the payer is going to deny and bundle into the antepartum care.