Ob-Gyn Coding Alert

Question: We have an ob patient who was just diagnosed with a heart murmur. The doctor is scheduling for her to have a fetal echo on the baby. What dx code would you use? Should I use 648.63?

Wyoming Subscriber

Answer: No. Code 648.63 (Other cardiovascular diseases of mother antepartum) would not be correct because a heart murmur NOS (785.2, Undiagnosed cardiac murmurs)  would be considered a symptom, not a definitive diagnosis for heart disease. The code range for 648.63 is 390-398 and 410-429, so unless the murmur has been attributed to a 424 code (valve issue), you would not use this code.

Instead, you should code 648.93 (Other current conditions classifiable elsewhere of mother antepartum) and 785.2, or go back to the ob-gyn for more information about the nature of the murmur. A heart murmur is classified as a symptom, not a disease until you find the source. Some murmurs are functional, meaning they cause no issues to the patient at all; just come and go.

ICD-10: When your diagnosis system changes, you’ll report the following codes instead:

• 648.63: O99.411,O99.412,O99.413, O99.419 (Diseases of the circulatory system complicating pregnancy, by trimester)

• 785.2: R01.0, Benign and innocent cardiac murmurs (includes functional heart murmur); R01.1, Cardiac murmur, unspecified (includes heart murmur NOS)

• 648.93: You would have to look up the exact “other” condition in the ICD-10 index to see if there is a comparable code as the translation table only indicates codes for malnutrition and endocrine disorders as applicable to this ICD-9 code.