ER pregt. patients


Best answers
I am fairly new to the coding world and need advice on coding pregnant patients who come through the ER. The doctors are not documenting whether or not this is a complication of pregnancy and getting them to answer my query connecting the two has been fruitless. I honestly believe they are throwing the query away; but that is beside the point.

In the guidelines, page 51, #16, Documentation of Complication of Care indicates a cause-and-effect relationship between the care provided and the condition. Does this mean that not all conditions a pregnant patient has is going to code as an OB code? I have had a pregnant patient come in with a sprained ankle; something I feel does not warrant an OB code, but a diagnosis of sprained ankle and a Z33.1, Pregnancy Incidental, code, (unless the physician documents otherwise.) What if the physician does not document at all whether or not it is a complication of care? Would this be where "cause-and-effect relationship" would come into play or do I need to walk down to see the physician when they are on duty for clarification?

Any help you could give me on this would be ever so helpful. I work with a seasoned coder who believes any and all pregnant patients who come through the ER is a complication of pregnancy. She believes this to be true because the physician is not documenting that it is not a complication of care. She assumes that it is. I am having trouble believing that per the guideline on page 51. I'm not trying to prove her wrong, but want to make sure I am coding these patients correctly.

Do you happen to know where there are articles on this subject for me to read? I have been searching for examples, clarification, reasoning, anything that would help me to better understand this area of coding and have been limited on my findings.

Thank you for all your advice. Sorry for the long letter, but this is very important to me and has been bothering me since I started this position.


True Blue
Columbia, MO
Best answers
You do not code pregnancy incidental unless the provider specifically documents that the pregnancy is incidental or that the condition does not affect or complicate the management of the pregnancy. All conditions need to be assumed to affect the pregnancy or the management. For your sprained ankle you would code the O9A.2-- code first, then your S code for the sprain then the Z3A for the weeks of gestation and then your external cause codes.