Ob-Gyn Coding Alert

Question: A patient presents to our office for karyotypic via amniotic fluid. What ICD-9 should I use?

California Subscriber

Answer: You should report V28.0 (Antenatal screening for chromosomal anomalies by amniocentesis) if your physician is performing the karyotyping to screen for chromosomal anomalies.

ICD-10: When your diagnosis coding system changes, you will report Z36 (Encounter for antenatal screening of mother) instead.

Important: An amniocentesis is not a routine test, however an ob-gyn usually orders this test only when the patient has a strong history of problems or has a current abnormal finding. Therefore, V28.0 may not be your primary diagnosis.

For instance, if the patient has a past history that is leading the patient to have the amniocentesis, you should use a V23 (Supervision of high-risk pregnancy) code. 

ICD-10: When your diagnosis coding system changes, you might be reporting a code from category O09.-- (Supervision of high risk pregnancy, …) with your fifth digit signifying trimester. 

Or maybe the patient had a positive AFP result? Usually, if the patient has an abnormal alpha-fetoprotein, that would be reason for doing the amniocentesis. You should code this by reporting 655.13 (Known or suspected chromosomal abnormality in fetus affecting management of mother; antepartum condition or complication).

ICD-10: When your diagnosis coding system changes, you will have a specific code for the abnormal finding and so you can report O28.5 (Abnormal chromosomal and genetic finding on antenatal screening of mother) or possibly O35.1--- (Maternal care for [suspected] chromosomal abnormality in fetus …) with your seventh digit signifying the specific fetus. 

Or is the ob-gyn doing the amnio because the patient is over 35? If so, you should report 659.63 (Elderly multigravida; other advanced maternal age antepartum condition or complication).

ICD-10: When your diagnosis coding system changes, you will report O09.52- (Supervision of elderly multigravida …) with your sixth digit signifying the trimester. 

Note: Karyotyping is a test to examine chromosomes in a sample of cells, which can help identify genetic problems as the cause of a disorder or disease. This test can:

• Count the number of chromosomes
• Look for structural changes in chromosomes.