Wiki O-codes in urgent care clinic

[Mary.e.barnes82@gmail.com]

Hello everyone,

I have a question regarding pregnancy ICD-10 codes and urgent care clinics. I am still new to coding, but I work for an urgent care clinic. We do not provide obstetric/maternity services; however, we do see patients that are pregnant for vaccinations, cold/flu/covid, uti and other outpatient services. The issue we are having is claims involving pregnant patients are being denied due to the O-codes. We have trained our providers to document whether the chief complaint is incidental to the pregnancy; however, this does not always happen. My question is should we be using the O-codes on claims that are not pregnancy related (such as a patient coming in for covid and flu testing)? I have been using dx code Z33.1, but my lead said that is incorrect. I appreciate any guidance and thank everyone in advance.

 

[Cmama12]

Hello everyone,

I have a question regarding pregnancy ICD-10 codes and urgent care clinics. I am still new to coding, but I work for an urgent care clinic. We do not provide obstetric/maternity services; however, we do see patients that are pregnant for vaccinations, cold/flu/covid, uti and other outpatient services. The issue we are having is claims involving pregnant patients are being denied due to the O-codes. We have trained our providers to document whether the chief complaint is incidental to the pregnancy; however, this does not always happen. My question is should we be using the O-codes on claims that are not pregnancy related (such as a patient coming in for covid and flu testing)? I have been using dx code Z33.1, but my lead said that is incorrect. I appreciate any guidance and thank everyone in advance.

The provider needs to document that it is incidental, you can't just add it. If it's not documented you should be using the O code. This is from the Chapter 15 guidelines - Codes from chapter 15 and sequencing priority: Obstetric cases require codes from chapter 15, codes in the range O00- O9A, Pregnancy, Childbirth, and the Puerperium. Chapter 15 codes have sequencing priority over codes from other chapters. Additional codes from other chapters may be used in conjunction with chapter 15 codes to further specify conditions. Should the provider document that the pregnancy is incidental to the encounter, then code Z33.1, Pregnant state, incidental, should be used in place of any chapter 15 codes. It is the provider’s responsibility to state that the condition being treated is not affecting the pregnancy.

 

[TThivierge]

Hi Mary
I d use the problem/illness of why pregnant patient is seeking care for such as J01,J45, R07.R15 and then add last dx code Z33.1 incidental pregnant code. If the provider list trimester add that last dx too.... see blocks Z3A . But provider should ask patient which trimester because the dx code for OB/GYN prego patients with certain illness . Usually must add additional dx code too.

Check out Dx. blocks which may apply if pregnant patient and ill.
....
UTI and Pregnant see dx 023.3 or 008 .83 block
Varicose Veins & Prego 027.8 block
DM and Prego 024.41 dx block
Anemia with prego status see dx block O09 or 090
Hypertensive HTN and with pregnancy see dx block 010 and 016
Vomiting during Pregnancy see dx. block 021.
Respiratory Ds and Pregnancy see dx block099.4
Digestive system and Prego see dx block 099.6
HIV status and pregnant see dx 098

Those are few examples but then add dx Z3A last on claim for the matching trimester patient has been documented in record for the day.

I hope this data helps you
Lady T