Ob-Gyn Coding Alert

Reader Question:

Follow the OB Drug Screening Rules of the Road

Question: Our providers are now performing a qualitative drug screen in our office on all OB Patients. I have heard that we should use V71.09 (Other suspected mental condition) as the diagnosis on this as drug dependance is considered a mental condition. Is this the appropriate diagnosis?

Also, even if we get a negative in the office, the providers are going to send to an outside lab for verification of the negative anyway. At this point, would the diagnosis remain the same, and would the codes not be the same since it would still be considered a qualitative d/t negative results? I think this will lead to insurance denials for duplicate billing.

How should I report this?

Georgia Subscriber

Answer: Careful there. The Supreme Court ruled in 2001 that you cannot do drug testing on pregnant women without their consent, so be sure you have it! Also, in some States, if you know the patient is taking drugs, there is a requirement to report that fact to a government agency. Tread carefully here as well and be sure your patients are aware of what might happen. Your physician’s documentation must clearly show the patient has given permission to do this drug testing.

In addition, American Congress of Obstetricians and Gynecologists (ACOG) does not recommend routine drug testing but rather drug screening consisting of a questionnaire about drug use (and alcohol use). If a problem is identified, the provider refers her to treatment. Per a Committee Opinion, “Physicians have an ethical obligation to learn and use techniques for universal screening questions, brief intervention, and referral to treatment in order to provide patients and their families with medical care that is state-of-the-art, comprehensive, and effective for drug use.”

Now even if you have her consent, you are still doing this on all patients whether you suspect drug use or not. Therefore, this is a screening. That means this is questionable as to whether you can call this routine antepartum screening since ACOG does not recommend such routine testing.

The only code that really applies is Z02.89 (Encounter for other administrative examinations) which may get the service denied by the payer. If the test result is negative, you no longer have medical justification for repeating the test. No payer is going to pay for two identical screening tests without medical need being established for the specific patient.

If you have reason to suspect drug use or you have a history of drug use, then your diagnosis code can change to something else, like O99.32- (Drug use complicating pregnancy, childbirth, and the puerperium) based on trimester if she is taking drugs, or possibly a O09 code if she has a history of drug use in her last pregnancy.

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