Ob-Gyn Coding Alert

Question: Our facility has a debate on when we should assign O99.5- (Diseases of the respiratory system complicating pregnancy, childbirth and puerperium). For example, pregnant patient, 18 weeks, presents with nasal congestion, headache and ear fullness. She denies any cough, chest pain, shortness of breath, fever, chills, dizziness, or changes in bowel or bladder function. Provider stated, “I do not feel that patient needs an antibiotic due to lack of signs of infection and pregnancy risks related to antibiotic use and said to use OTC meds.” Diagnosed patient with Seasonal Allergic Rhinitis. Codes assigned were O99.512

(Diseases of the respiratory system complicating pregnancy, second trimester) and J30.2 (Other seasonal allergic rhinitis). Would this be considered a “disease of the respiratory system complicating pregnancy?” Provider didn’t indicate the rhinitis was or was NOT complicating the pregnancy, so I think this is where the confusion is. Do you have any insight?

Alabama Subscriber

Answer:  You should absolutely code the O99.512 and J30.2 along with Z3A.18 (18 weeks gestation of pregnancy). O codes are the pregnancy codes with complications, and the seasonal allergic rhinitis is complicating the pregnancy. The ob-gyn must take into consideration the patient is pregnant and treat patient accordingly. They cannot treat a pregnant patient the same as they would treat a patient who is not pregnant. Certain medications can cause issues and harm the baby. So yes, the seasonal allergic rhinitis is complicating the pregnancy.

Important: The physician must indicate that the condition is not complicating pregnancy to use a non-ob code and “pregnancy incidental” code as primary. If he/she does not, you default to the ob-related code as primary.