Wiki OB Coding Z34 vs O09.9

[MLH614]

I'm stuck on this and I can't find a definitive answer anywhere. A routine prenatal encounter requires a Z34 code unless a code from chapter 15 is used. If a code from chapter 15 is used does it automatically make it a high risk pregnancy?

For example if a O21.9 dx is coded then what is the first listed diagnosis? You can't use a z34 code but do you then use an O09.90-O09.93 dx?

See my screenshots below. The first is the coding guidelines and the second is just a list from the medicare medical necessity document that one of these codes is required for certain labs. So if you can't use a Z34 code. How do you get the lab covered? Use an O09 code?

 

[Cmama12]

I'm stuck on this and I can't find a definitive answer anywhere. A routine prenatal encounter requires a Z34 code unless a code from chapter 15 is used. If a code from chapter 15 is used does it automatically make it a high risk pregnancy?

No, it doesn't. It just means there is an issue/complication/complaint, which could be minor.

For example if a O21.9 dx is coded then what is the first listed diagnosis? You can't use a z34 code but do you then use an O09.90-O09.93 dx?

O21.9 by itself is acceptable as a 1st listed. You would not necessarily add anything else.

So if you can't use a Z34 code. How do you get the lab covered? Use an O09 code?

What labs?

 

[MLH614]

No, it doesn't. It just means there is an issue/complication/complaint, which could be minor.

O21.9 by itself is acceptable as a 1st listed. You would not necessarily add anything else.

What labs?

Thank you! the wording in the guidelines was confusing me.

These are some of the labs our OB providers are ordering:

80055 - ob panel
83020 - hemoglobin
87086 - urine bac culture
80307 - drug screen
87491 - Chlamydia, gonorrhea, trichomonas
86803 - hep c
81420 - MaterniT21
87389 - HIV

We use labcorp and a lot of labs are coming back showing not covered and I'm trying to figure out why. Any lab coding resources you can suggest or any OB coding resources would be appreciated!