Neurology & Pain Management Coding Alert

Question: Our neurologist saw a patient for consultation at the request of her obstetrician. The patient is currently pregnant with a history of a rupture brain aneurysm (in 2010) and currently has metallic coiled. Patient was requesting her OB to do a vaginal delivery, my doctor advised against the vaginal delivery due to her history.

My neurologist wants to bill her insurance with diagnosis code V22.0, but I say we can’t bill with this diagnosis because we consulted the patient for the history of the brain aneurysm, and that the secondary diagnosis will be the pregnancy. Am I correct in billing the history of the brain aneurysm?

South Carolina Subscriber

Answer:  Code V22.0 (Supervision of normal first pregnancy) means the physician is supervising a normal pregnancy. In this case the patient has a history of an aneurysm, which is complicating the management of the pregnancy.

Because she is pregnant, the primary diagnosis code must be one from the OB complications chapter unless the physician has documented that this condition is incidental to pregnancy (which is obviously not the case here). Since your physician is not an OB, the payer will reimburse for the consult separately before delivery even though you use an OB complication code.

None of the V23 (Supervision of high-risk pregnancy) codes apply because although she has a high risk pregnancy, your neurologist is not supervising all of her care. Instead, you should report 648.93 (Other current conditions classifiable elsewhere of mother antepartum) with V12.59 (Personal history of other diseases of circulatory system not elsewhere classified). You would not report 674.03 (Antepartum cerebrovascular disorders) because she does not currently have an aneurysm (or I am assuming she does not). The fifth digit of “3” is required because she is in the antepartum period.