Reader Question:
Assign Diagnosis Based on Reason for Visit
Published on Tue Mar 30, 2004
Question: We always perform a pregnancy test before we give a patient a Depo-Provera injection. A particular patient is an insulin-dependent diabetic. I therefore coded the test with V25.02 but did not include the diabetic code. The carrier denied the claim. How should I have coded this?
Kentucky Subscriber Answer: You must code for the reason the ob-gyn performed the pregnancy test (for example, 81025, Urine pregnancy test, by visual color comparison methods). Therefore, you were correct to report only V25.02 (General counseling and advice; initiation of other contraceptive measures).
The physician is not administering the Depo-Provera (J1051, Injection, medroxy-progesterone acetate, 50 mg) because the patient is diabetic. And he did not perform the pregnancy test because she is diabetic.
By denying the service, the payer is telling you that it will not pay for a pregnancy test prior to the doctor initiating contraception. You should ask the carrier its policy regarding this issue, and if the insurer does not cover the pregnancy test in this situation, you should be able to bill the patient. -- The answers for Reader Questions and You Be the Coder were provided by Melanie Witt, RN, CPC, MA, an ob-gyn coding expert based in Fredericksburg, Va.; and Harry L. Stuber, MD, an independent gynecologist based in Cookeville, Tenn.
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