Wiki Unknown pregnancy

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JDM1228

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A patient came into our E/R with complaints of nausea, vomiting, and abdominal pain. Part of the work-up was a pregnancy test which was positive. She also had a UTI. The patient did not know she was pregnant and unfortunately did not have maternity coverage with her insurance which denied the visit. The diagnosis codes assigned were 643.93, 646.63, & 599.0. Below are the diagnoses listed on the E/R physician's report. My question is whether or not we have any other choice besides using the pregnancy related dx codes? She had these symptoms that are most likely due to being pregnant, but like the patient said, she wouldn't have come to the E/R if she had known her symptoms were due to that. I know I am stretching, but this comes up quite a number of times. However, I do want to be accurate with the coding. Thanks!!

Impression and Plan
Diagnosis
Nausea 787.02 (ICD9 787.02, Discharge, Emergency medicine, Medical)
Urinary tract infection 599.0 (ICD9 599.0, Discharge, Emergency medicine, Medical)
Diagnosis
Vomiting (Reason For Visit, Medical)
Nausea 787.02 (ICD9 787.02, Discharge, Emergency medicine, Medical)
Urinary tract infection 599.0 (ICD9 599.0, Discharge, Emergency medicine, Medical)
Normal pregnancy, first (ICD9 V22.0, Discharge, Medical)
 
JDM1228 said:
A patient came into our E/R with complaints of nausea, vomiting, and abdominal pain. Part of the work-up was a pregnancy test which was positive. She also had a UTI. The patient did not know she was pregnant and unfortunately did not have maternity coverage with her insurance which denied the visit. The diagnosis codes assigned were 643.93, 646.63, & 599.0. Below are the diagnoses listed on the E/R physician's report. My question is whether or not we have any other choice besides using the pregnancy related dx codes? She had these symptoms that are most likely due to being pregnant, but like the patient said, she wouldn't have come to the E/R if she had known her symptoms were due to that. I know I am stretching, but this comes up quite a number of times. However, I do want to be accurate with the coding. Thanks!!

Impression and Plan
Diagnosis
Nausea 787.02 (ICD9 787.02, Discharge, Emergency medicine, Medical)
Urinary tract infection 599.0 (ICD9 599.0, Discharge, Emergency medicine, Medical)
Diagnosis
Vomiting (Reason For Visit, Medical)
Nausea 787.02 (ICD9 787.02, Discharge, Emergency medicine, Medical)
Urinary tract infection 599.0 (ICD9 599.0, Discharge, Emergency medicine, Medical)
Normal pregnancy, first (ICD9 V22.0, Discharge, Medical)
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Once it is determined the patient is pregnant then you must code the pregnancy first unless the provider documents that the pregnancy is incidental which he did not. You would code the 646.63 for the UTI but do not add the 599.0 since that is redundant. It appears that the only dx she had was the UTI as the symptoms were related to that dx
 
unknown pregnancy

It is unfortunate that she does not have maternity coverage but that is not the facility's fault. She was found to be pregnant and that diagnosis was medically necessary for her treatment. Her statement that she would never have come to the emergency department had she known she was pregnant could be seen as an attempt to negate her responsibility according to her insurance coverage and shift it to the ER.
 
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