Wiki OB code sequencing - we're having a debate

Create Wiki
C

Cmama12

Expert
Messages
371
Best answers
1
As we all know, the Chapter 15 guidelines state that Chapter 15 codes have sequencing priority over codes from other chapters. After many, many years of OB coding, we are now having a discussion as to whether this means that ALL the O codes should be listed before ALL the other codes, or if it just means for each condition, the O code should be sequenced first. The examples in the ICD 10 book as well as online only seem to show one condition. So when a patient has multiple conditions, for example, a 36-wks gestation patient has anemia, essential hypertension and obesity, how would you sequence the codes, example A or B?

Example A
O99.013
O10.013
O99.213
D64.9
I10
E66.9
Z3a.36

Example B
O99.013
D64.9
O10.013
I10
O99.213
E66.9
Z3a.36
 
I would not code I10 and D64.9 as those conditions are already described in O99.013 and O10.013, respectively. Otherwise, I would follow example B when the specific code instructs to use an additional code that might describe higher specificity of a condition which is complicating the pregnancy.

--
Ryan Stroup, CPC

*Please excuse any delay in receiving this response as my posts require moderator approval prior to being visible.
 
Cmama12 said:
As we all know, the Chapter 15 guidelines state that Chapter 15 codes have sequencing priority over codes from other chapters. After many, many years of OB coding, we are now having a discussion as to whether this means that ALL the O codes should be listed before ALL the other codes, or if it just means for each condition, the O code should be sequenced first. The examples in the ICD 10 book as well as online only seem to show one condition. So when a patient has multiple conditions, for example, a 36-wks gestation patient has anemia, essential hypertension and obesity, how would you sequence the codes, example A or B?

Example A
O99.013
O10.013
O99.213
D64.9
I10
E66.9
Z3a.36
Click to expand...
The ICD10 guidelines do not address this issue directly, but in multiple examples they have provided via their Q&A they indicate that as long as the primary/first listed Dx is from Chapter 15, the other diagnoses used would follow whatever rule was attached to the O code reported. But keep in mind that you want the most important reasons directly related to the admission or current treatment first. If that means you have a payer that will only accept 4 Dx codes on the claim, and your first 3 are very important but require use of an additional code, you might lose out on the complexity of the case. The payer can always come back to you for more information and the O code listed would normally be descriptive enough 9 times out of 10.
 
I'll also weigh in. I also believe as long as the first code is your O99.013, either example A or example B would be correct. I personally would probably code as example A with all my Chapter 15 codes before any others, but would certainly not consider B wrong. I would call example A more correct.
 
rstroup said:
I would not code I10 and D64.9 as those conditions are already described in O99.013 and O10.013, respectively. Otherwise, I would follow example B when the specific code instructs to use an additional code that might describe higher specificity of a condition which is complicating the pregnancy.

--
Ryan Stroup, CPC

*Please excuse any delay in receiving this response as my posts require moderator approval prior to being visible.
Click to expand...
Thanks, agree O10 - I'm just so used to adding the additional codes - however, for anemia there is a "use additional code" note under O99 category heading, which would apply to all codes in that section.
 
You must log in or register to reply here.
Top