For the Record: Ask the Expert Section

For the Record magazine is a leader in the health care publication industry and it often receives questions from the readership on tricky issues. This week Shelly Cronin, CPC, CPMA, CANPC, CGSC, CGIC AAPC’s CEU vendor manager answered a question about pregnancy coding guidelines. Janie Randall-Payne, BS, CPC-I, CPC-H, CPC, CCS-P, PCS, CPAR asked the following question:

“According to pregnancy coding guidelines, if the condition being treated doesn’t affect or isn’t affected by the pregnancy, the physician must specifically document this information in the medical record. If the pregnancy does not seem to impact the visit but the provider does not state that in the documentation, can you code it as incidental? How do you code it?”

Cronin’s response was “[c]oding has to follow guidelines and include the required information in the documentation. If the provider does not document the information, it would be inappropriate to assume that the patient’s pregnancy is incidental to the condition or treatment. You should go to the provider and ask him or her whether a causal relationship exists between the condition or treatment and the patient’s pregnant state before applying a code.”

Anesthesia and Pain Management CANPC

The “Ask the Expert” section is available only through the For the Record email subscription.

One Response to “For the Record: Ask the Expert Section”

  1. Eilet Semper says:

    good afternoon,
    I am not getting paid from Medicare on 96416 and I do not know what to use in place of it. I did try using G0498 but still no payment. any answers on this

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