Ob-Gyn Coding Alert

You Be the Coder:

Round Ligament or Abdominal Pain

Test your coding knowledge. Determine how you would code this situation before looking at the box below for the answer.

Question: Is there an ob code we can use when a patient is seen for round ligament pain or abdominal pain? ICD-9 doesnt seem to have anything like this.

Shelly Bunting, Insurance Manager
LowCountry Womens Specialists
North Charleston, S.C.

Answer: Unfortunately there is no perfect code in the ob chapter of ICD-9 for a complaint of round ligament pain or abdominal pain and this is one time when searching the alphabetic index will be of no help. But you can come close by analyzing the type of complaint and going directly to the tabular index. ICD-9 has two code categories that might apply in this case646 (other complications of pregnancy not elsewhere classified) and 648 (other current condition in the mother classifiable elsewhere). To decide which tabular category will be best " you need to define the problem and determine whether it is a complication of pregnancy or a condition that the patient would have had anyway.

Round ligaments are fibromuscular bands that extend from the superior lateral surface of the uterus (but do not support the uterus" only keep it in the correct position) downward laterally and forward through the inguinal canal to terminate in the labia majora. It is therefore possible that the growing fetus may exert pressure on these ligaments and the patient may complain of pain in the lower abdominal or groin area. Abdominal pain can be related to pregnancy due to false labor or contractions but also can be a function of pressure from the baby or a mass developing within the pelvis. Therefore if the physician is attributing the round ligament or abdominal pain to the pregnancy 646.8 (other specified complications of pregnancy) would be the correct code. If the physician believes that the pain is due to a problem unrelated to the pregnancy 648.9 (other current conditions classifiable elsewhere) would be reported. In either case you can add a secondary diagnosis of abdominal pain (789.0X where the fifth digit represents the site of the pain).