Wiki abdominal pain and pregnancy in ED

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Code: R10.30

Code Name: ICD-10 Code for Lower abdominal pain, unspecified

Block: Lower abdominal pain, unspecified

R10

Excludes1: renal colic (N23)

Excludes2: dorsalgia (M54.-)
flatulence and related conditions (R14.-)

Details: Symptoms and signs involving the digestive system and abdomen (R10-R19)

Excludes 2: congenital or infantile pylorospasm (Q40.0)
gastrointestinal hemorrhage (K92.0-K92.2)
intestinal obstruction (K56.-)
newborn gastrointestinal hemorrhage (P54.0-P54.3)
newborn intestinal obstruction (P76.-)
pylorospasm (K31.3)
signs and symptoms involving the urinary system (R30-R39)
symptoms referable to female genital organs (N94.-)
symptoms referable to male genital organs male (N48-N50)

Guidelines: Symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified (R00-R99)

Note: This chapter includes symptoms, signs, abnormal results of clinical or other investigative procedures, and ill-defined conditions regarding which no diagnosis classifiable elsewhere is recorded.
Signs and symptoms that point rather definitely to a given diagnosis have been assigned to a category in other chapters of the classification. In general, categories in this chapter include the less well-defined conditions and symptoms that, without the necessary study of the case to establish a final diagnosis, point perhaps equally to two or more diseases or to two or more systems of the body. Practically all categories in the chapter could be designated 'not otherwise specified', 'unknown etiology' or 'transient'. The Alphabetical Index should be consulted to determine which symptoms and signs are to be allocated here and which to other chapters. The residual subcategories, numbered .8, are generally provided for other relevant symptoms that cannot be allocated elsewhere in the classification.
The conditions and signs or symptoms included in categories R00-R94 consist of:
(a) cases for which no more specific diagnosis can be made even after all the facts bearing on the case have been investigated;
(b) signs or symptoms existing at the time of initial encounter that proved to be transient and whose causes could not be determined;
(c) provisional diagnosis in a patient who failed to return for further investigation or care;
(d) cases referred elsewhere for investigation or treatment before the diagnosis was made;
(e) cases in which a more precise diagnosis was not available for any other reason;
(f) certain symptoms, for which supplementary information is provided, that represent important problems in medical care in their own right.


Excludes 2: abnormal findings on antenatal screening of mother (O28.-)
certain conditions originating in the perinatal period (P04-P96)
signs and symptoms classified in the body system chapters
signs and symptoms of breast (N63, N64.5)

For more details on R10.30 , ICD-10 Code for Lower abdominal pain, unspecified , visit: https://coder.aapc.com/icd-10-codes/

kviolet

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What dx will be for pt with abdominal pain and pragnant in ED, where can I find more info about that ?
Thanks
 

hunt

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789.00 abdominal pain unspecified site and v22.2 pregnant state,incidental.:)
 

smwermter

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I disagree. I believe that should be coded 648.93 current condition in mother comlicating pregnancy, antepartum and 789.00 abdominal pain, unspecified site. Unless the physician specifies that the pregnancy is incidental to the reason for the visit (abdominal pain). Here is the official coding guideline on this subject:

ICD-9-CM Official Guidelines For Coding And Reporting
Effective November 15, 2006

The guidelines include the updated V Code Table

11. Chapter 11: Complications Of Pregnancy, Childbirth, And The Puerperium (630-677)

a. General Rules For Obstetric Cases

1) Codes from chapter 11 and sequencing priority

Obstetric cases require codes from chapter 11, codes in the range 630-677, Complications of Pregnancy, Childbirth, and the Puerperium. Chapter 11 codes have sequencing priority over codes from other chapters. Additional codes from other chapters may be used in conjunction with chapter 11 codes to further specify conditions. Should the provider document that the pregnancy is incidental to the encounter, then code V22.2 should be used in place of any chapter 11 codes. It is the provider's responsibility to state that the condition being treated is not affecting the pregnancy.
 

KimberlySherman

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I agree with using a chapter 11 code if possible. I always have trouble with 648.9X because the ICD book states which corresponding illness codes are covered by 648.9X. 789.00 is not in that range of codes. So, you either have to disregard the list of corresponding codes, or you have to "misuse" V22.2. Hopefully ICD-10 will have better coverage of conditions during pregnancy.
 

Mojo

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This very scenario is addressed in the ED Practicum for the CEDC. Code 646.83, 789.00.

V22.2 is only used when the provider documents that the condition being treated is not affecting the pregnancy.

The Ingenix Expert ICD-9 has a Resources section in the back for pregnancy codes (at least 2010 has it, I have the AAPC ICD-9 for 2011). Under antepartum, pains 646.83 is listed with a note to assign an additional code to describe the condition.
 

eadun2000

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100000% agree with mojo and whomever said to misuse the V22.2.. that is just plain insane. You can't just use V22.2 because you are unsure of the proper complication of pregnancy code. Heck, you can't just use any code period because you couldn't find or didn't want to take the time to find the code. Why even bother coding then? We are held to a HIGH standard. Using a code just because you can't find another (and knowing it is wrong) is well below any standard. Just my two cents.
 

ptrautner

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Re: abdomen pain and pregnancy in the ED

it depends on what discipline you were taught in, AAPC seems to teach to use the incidental v code and Ahima will tell you to always use a comp code unless the provider indicates in documentation that the pregnancy is incidental to what the patient is being treated for. i always use the comp code for pregnancy .
 

DCoburn

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Help with CPT suggestion

I know this is an late entry but, I had to code a similar situation as follows: The pt came to the emergency dept because she had injured her big toe. The ED physician diagnosis was sprain of the first digit left foot. Althought it was documented in the chief complaint that the pt was pregnant, the ED physician did not address the pregnancy.

Correct me if I am wrong however, all the documentation was addressing the the sprained toe with no further mention of the pregnancy. I think this qualifies for use of V22.2 for the pregnancy state instead of an pregenancy complication code.

Just my late 1 1/2 cents

DC
 

mitchellde

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Just because the pregnancy was not overtly addressed in the treatment and assessment it was taken into consideration when they decided on the treatment. You cannot use V22.2 without specific documentation as MOJO and others have stated. You may think it qualifies as a V22.2 but the provider did not document for that code therefore we must code as MOJO has directed, there is no other choice.
 
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I agree that unless the Provider specifically states that the pregnancy is coincidental to reason patient is being seen it is coded as a complication! ER visits included!
 

PeaPod1

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Agree with Debra 100%! Everything I have been taught regarding the above situation is that the provider must state that it is completely unrelated/has no impact on the medical decision making and this must be clearly documented, for you to not consider the pregnancy.
Great post on this subject.
 

TamaraM

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Shouldn't it have to do with the outcome. I have the same situaltion, patient comes in to ER

"Abdominal pain with pregnancy."

Fetal ultrasound is done

FINDINGS: A single live intrauterine pregnancy is identified. Composite assessment of gestational age is 17 weeks 4 days. HC/AC ratio is 1.2 and is normal. Survey of fetal anatomy is normal. The lateral ventricles are not visualized. There is normal amount of amniotic fluid. Placenta is posterior and a grade 0.
IMPRESSION: Single live intrauterine pregnancy of approximately 17 weeks 4 days.

....
So should I truely use 646.83 & 789.00 if nothing is complicating the pregnancy??

If nothing is found to be affecting the pregnancy then I believe you should code the symptom and incidental pregnancy.
 

C Clark CPC CEDC

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Pregnancy Diagnosis Code(s)

I agree.. 646.83 & 789.09


FYI:
In our ICD9 book under Coding Tables there's a section for Antepartum & Postpartum.
Listed in these section's are symptoms/diseases etc...Also there is a column in this same section "Assign additional code to describe cause/condition".

I refer to this section frequently...it's very helpful..
 

Mojo

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Shouldn't it have to do with the outcome. No, it depends on the provider's documentation. I have the same situaltion, patient comes in to ER

"Abdominal pain with pregnancy."

Fetal ultrasound is done

FINDINGS: A single live intrauterine pregnancy is identified. Composite assessment of gestational age is 17 weeks 4 days. HC/AC ratio is 1.2 and is normal. Survey of fetal anatomy is normal. The lateral ventricles are not visualized. There is normal amount of amniotic fluid. Placenta is posterior and a grade 0.
IMPRESSION: Single live intrauterine pregnancy of approximately 17 weeks 4 days.

....
So should I truely use 646.83 & 789.00 if nothing is complicating the pregnancy?? Yes, unless the documentation states the pregnancy is incidental to the encounter.

If nothing is found to be affecting the pregnancy then I believe you should code the symptom and incidental pregnancy. No, the provider determines if the encounter is incidental.
As others have suggested, read the chapter 11 guidelines. The guidelines note it is the provider's responsibility to state that the condition being treated is not affecting the pregnancy to assign V22.2 in place of chapter 11 codes.
 

lesterbelen

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It's 648.9x

I would go with 648.9x for the pregnancy code becuase the abdominal pain is a current condition.

789.0x as additional code.

I have just taken a CCS exam prep class at The Roxbury here in Queens, NY (from Oct. 26-Dec. 14, 2013) and we discussed this very same coding situation. This includes back pain with pregnancy, also to be coded as 648.9x plus the back pain code.
 
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