Ob-Gyn Coding Alert
Familiarize Yourself With These Five Obstetric Areas Changing October 1
You’ll make a new distinction between ectopic and molar pregnancies.
Last month, you learned about the gynecological ICD-10 codes to expect October 1, 2016. Now, check out the obstetric changes heading your way, which include new codes Z31.7 (Encounter for procreative management and counseling for gestational carrier) and Z33.3 (Pregnant state, gestational carrier).
To get the full picture, look at these five new changes that will affect your obstetric practice.
1. Deleted Pregnancy Codes Each Become Two More Detailed Versions
You’ve got expanded options to replace the following deletions.
You’ll delete O00.0 (Abdominal pregnancy). Instead, you should add O00.00 (Abdominal pregnancy without intrauterine pregnancy) and O00.01 (Abdominal pregnancy with intrauterine pregnancy).
You will cross out O00.1 (Tubal pregnancy). You should add O00.10 (Tubal pregnancy without intrauterine pregnancy) and O00.11 (Tubal pregnancy with intrauterine pregnancy).
Get ready to erase O00.2 (Ovarian pregnancy) from your coding cache, and look to these options instead: O00.20 (Ovarian pregnancy without intrauterine pregnancy) and O00.21 (Ovarian pregnancy with intrauterine pregnancy).
Forget O00.8 (Other ectopic pregnancy), because you will report O00.80 (Other ectopic pregnancy without intrauterine pregnancy) and O00.81 (Other ectopic pregnancy with intrauterine pregnancy) instead.
Similarly, you’ll delete O00.9 (Ectopic pregnancy, unspecified) and look to O00.90 (Unspecified ectopic pregnancy without intrauterine pregnancy) and O00.91 (Unspecified ectopic pregnancy with intrauterine pregnancy) instead.
“These changes are welcome as they represent the old ICD-9 terminology and because there was no way in ICD-10 to report an ectopic with an intrauterine pregnancy otherwise,” says Melanie Witt, RN, MA, independent ob-gyn consultant in Guadalupita, N.M. “This occurs more frequently in women who have had ovulation induction or assisted reproductive procedures.”
2. Don’t Overlook These Molar Revisions, Additions
Ectopic pregnancy conditions also get a descriptor revision. Codes O09.1- (Supervision of pregnancy with history of ectopic or molar pregnancy, …) will become (Supervision of pregnancy with history of ectopic pregnancy, …). The fifth digit will specify trimester.
If you notice, the revision removes the mention of molar pregnancy. That’s because molar pregnancies get their own codes:
“These changes were made because an ectopic and molar pregnancy are totally distinct from one another and each requires different patient management. This should make it clear to payers that treatments are appropriate for the condition,” Witt says.
3. Untangle These Complication Codes
You need to examine complication codes, because you have more options from which to choose.
Get ready to use O11.4 (Pre-existing hypertension with pre-eclampsia, complicating childbirth) and O11.5 (Pre-existing hypertension with pre-eclampsia, complicating the puerperium).
You’ll have these new conditions:
You’ll also have these options:
Your O14 codes will expand to include:
You also have revisions, such as these eclampsia descriptors:
Heads up: You will also add O16.4 (Unspecified maternal hypertension, complicating childbirth) and O16.5 (Unspecified maternal hypertension, complicating the puerperium).
4. Here’s How You’ll Overhaul Gestational Diabetes Dx
Expert advice: “The O24.0- and O24.1- changes represent only a more clinically correct description of both type 1 and type 2 diabetes; this change does not alter the use of these codes. However, the changes to the gestational diabetes codes bring us to the complete picture. Until now, we only had code for dietary and insulin control of gestational diabetes. In October, we will add control with hypoglycemic agents (such as Glyburide or Metformin),” Witt says. “These options for treatment are much more common. “
Important: The tabular index will also include a note to use an additional code to identify the type of control using new code Z79.84 (Long term [current] use of oral hypoglycemic drugs) with all type 2 diabetic codes. This means that if you are reporting either an E11 code (type 2 diabetes) or an O24.1- code, Z79.84 will need to be also reported if the patient is taking oral medication. This new code will not be reported with the gestational diabetes codes, since the new codes include this information. As a reminder, correct coding for a type 2 diabetic pregnant patient would require reporting O24.1-, an E11 code for manifestations, and either Z79.4 for insulin control or new code Z79.84 for hypoglycemic control.
Take note of the following revisions:
You’ve also got these new codes from which to choose:
5. Don’t Miss These Other Miscellaneous Codes
You will delete O33.7 (Maternal care for disproportion due to other fetal deformities), and then you will add the following expanded options:
You will also cross out O34.21 (Maternal care for scar from previous cesarean delivery) and add the following expanded options:
You’ve got some more revisions to understand, as well:
Additionally, you will add the following codes:
Clinically, a “complete” previa will mean that the internal cervical os is completely covered by the placenta. “Partial” indicates that the placenta only covers part of the cervical os. “Low lying” means that the placenta implants low in the uterus but does not cover the cervix. Provider documentation will need to clearly make this distinction in order to code correctly, Witt says.
Finally, you will delete O70.2 (Third degree perineal laceration during delivery) and add these expanded options:
Again, documentation will be important, Witt says. The American Congress of Obstetricians and Gynecologists (ACOG) requested this change to improve data with regard to this type of laceration. Type 3a means that less than 50% of the External Anal Sphincter (EAS) is torn; type 3b indicates that more than 50% of the EAS is torn; and type 3c would mean that both the external and internal anal sphincter are torn.
Remember: The list is not yet final. “The code lists that have been posted on the CMS and CDC websites are NOT the final list. The Addenda to be published in June is the complete, final list of code changes going into effect this October,” says Sue Bowman, MJ, RHIA, CCS, FAHIMA, Senior Director of Coding Policy and Compliance at AHIMA.
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