Complicated and Routine Prenatal Diagnosis Coding

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Caneyville, KY
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I am posting this to seek clarification due to some mixed feelings had around using "Z" and "O" codes during a pregnancy. I do know that the ICD-10 Coding Guidelines Chapter 15 b. 1 and 2 state that Z codes cannot be used with O codes and visa versa. Obviously if there is a service for screening I would use the appropriate Z36 code relating to that service being performed.

Is there ever an instance you can use both on the same claim but not the same line item?

Patient is coming in for normal OB visit and turns out she is having severe pain after ultrasound she appears to have a cyst on her ovaries. She comes in for her next routine OB and has routine labs scheduled cyst still present of course. There is an impression that we can bill the labs as normal routine but the ultrasound has to be billed as Complicated.

Another scenario is just lab related: Anyone that would normally have the z34.xx codes would not have the Z34 code replaced with an O code if one of the other labs (rh negative needing ab screen, etc) needed an O code, so in those instances the claim would have both the Z34 code and an O code, just not on the same line. [ I see this and think that if they are Rh Negative then that code would be applicable for all routine labs billed and they should not be denied.)

Some patients get hot under the collar for not using a normal routine prenatal code when they have a "complicated pregnancy" as their carrier applies that to non preventive services as it is no longer a normal pregnancy, but if it was normal it would be covered 100%.

The grey areas in coding can make things so complicated and I have found that asking many different coders/billers you get different answers.

Any insight would be greatly appreciated.
 
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2
Location
Caneyville, KY
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I am bumping this as we have the same thing happening in our clinic and I am trying to find any documentation that proves we can use routine and complicated. From all of my reading and research I am finding that it says if a patient has a complicated pregnancy the proper O codes should be assigned for the care and with that I assume even for the lab work. We have patients for example that are documented as Obese complicating pregnancy but we drop all lab work as normal. I highly disagree with this and would like clarification. I am going to actually post this link on my Linked in for thoughts.
 
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