Ob-Gyn Coding Alert

Tip: Break down these codes into problem-oriented, fact-oriented, and service-oriented.

The carrier of genetic disease (V18.9) is fact-oriented, while the screening (V26.31), other gene testing (V26.32) and genetic counseling (V26.33) are all service-oriented, says Nadia Noor, CPC, a reimbursement specialist at the Austin Diagnostic Clinic in Texas.

"I expect coders will probably use V18.9 to support more frequent ultrasound tests, V26.31 when a family history suggests the individual is at risk (such as, the father has Huntington's), V26.32 for a habitual aborter coming in to verify germ cells have the same karyotype as somatic cells, and V26.33 when this is the sole reason for the visit," says Nancy Reading, RN, BS, CEO of Cedar Edge Medical Coding and Reimbursement in Centerfield, Utah.

Red flag: Because your ob-gyn will find that most couples will turn out to be non-carriers, you should make sure that you don't use disease codes for the screening encounter. Even if they are carriers, these couples do not have the genetic disease themselves, so you shouldn't apply the disease codes to them.

2. Broaden Obesity Reporting With BMI Codes

In the past, you would only find the terms "obesity" and "morbid obesity," but now you'll have unique codes for "overweight" (278.02) and "body mass index(BMI)" (V85.x).

The 278.0 category codes will be retitled "overweight and obesity," and you'll have a set of BMI status codes to use in conjunction with them in order to provide the most specific information about a patient's weight, or weight-to- height ratio.

"I can foresee using BMI codes whenever appropriate, especially for pregnant or infertile patients, if it helped complete the picture of their condition(s)," says a coding instructor in Santa Rosa, Calif.

These BMI status codes include: 

"We currently add codes for obesity whenever it is a pertinent diagnosis, for example, in high-risk pregnancies with diabetes," the coding instructor says.

Note: Don't focus too hard on the obesity factor. You can use BMI codes for underweight patients as well.

"You can use these BMI codes to represent a standard of measurement for treating malnutrition, anorexia, bulimia, or as a cut-off point for who might qualify for a gastric bypass and have it paid for," Reading says.

For now: If an ob-gyn determines that a patient is morbidly obese, you should assign 278.01 (Morbid obesity). ICD-9 defines morbid obesity as "increased weight beyond limits of skeletal and physical requirements (125 percent or more over ideal body weight), as a result of excess fat in subcutaneous connective tissues."

Exception: When the patient's increased weight is due to a medical condition, such as a thyroid problem, report the underlying condition instead of morbid obesity.

Problem area: You should report 278.00 (Obesity, unspecified) to indicate significant obesity that doesn't qualify as morbid obesity. Insurers have different criteria for 278.00. Some companies make no payment on claims containing this diagnosis due to plan exclusions.

For instance, after an ob-gyn diagnoses a patient with obesity that doesn't qualify as morbid obesity, a nurse practitioner may counsel the woman on proper diet and exercise. The insurer doesn't cover obesity-related services, so you should code the appropriate-level office visit (99212-99215, Office or other outpatient visit for the evaluation and management of an established patient) with a diagnosis of unspecified obesity (278.00) and charge the patient for the service.

3. Evaluate Anonymous/Designated Donor Codes

You'll find new and better ways to specify the age of an egg donor and whether the donor intends the ob-gyn to use the eggs for anonymous donations or for a designated recipient in ICD-9 2006. These ACOG-requested codes are: 

"We do egg donor cycles, both known (as in, sister to sister) and anonymous cycles. For anonymous cycles, we have a pool of donors who go through specified testing, including psych evaluation," Kroening says. "This new age breakdown will help us with data analysis."

For now: When you report an egg donation for an anonymous recipient, you should use V59.8 (Donor of other specified organ or tissue). Keep in mind that if you want to code for a sperm donation after Oct. 1, you should continue to turn to V59.8.

In the future: You can get more specific and report V59.7x for the egg donor.