Ob-Gyn Coding Alert

Question: Should a pregnancy that was achieved on Clomid be coded as high risk?


California Subscriber

Answer: Not necessarily. For the visits up to the point where the danger has passed, you can assign V23.0 (Supervision of pregnancy with history of infertility) as part of the record. But if she delivers normally, you will bill the global ob package using diagnosis 650 (Normal delivery), assuming the patient has one fetus, vertex position, and so on. Don't forget V27.0 (Single liveborn).

Ob-gyns use Clomid to induce ovulation and increase the number and size of follicles produced. This means that there is more potential for the patient to carry twins or other multiple gestation, to have an ectopic pregnancy if the larger egg gets trapped in the fallopian tube, or to miscarry early due to a thinner uterine lining (a side effect of the drug for some women).

The ob-gyn will discover these problems in the first trimester. In other words, once the patient is beyond 14 weeks without any of these problems developing, the ob-gyn will not consider the pregnancy high risk. But if any of these problems do develop, you would of course use the diagnostic code that represents the condition and no longer use the high-risk code.