Supervision of high risk pregnancy code rage O09-

[arbucklej]

Hi, looking for coding advice from an old case:
31-year-old patient here for prenatal visit who brought her baby with her today. The patients last menstrual period was 2/22/2024. She is sure of the dates and states she cycles every 35 days. Her last pregnancy was complicated with preterm delivery and hemolysis, elevated liver enzymes, and low platelets and at 34wks suffered intrauterine growth restriction and postpartum hemorrhage. She delivered by cesarean and states she wants vbac this time (vaginal birth after c-section). Today’s assessment and plan is as follows: pt is at 10 weeks, has a hx of severe preeclampsia and hellp at 34 wks therefore baseline labs ordered. She also has a Hx of postpartum vte (venous thromboembolism). When the patient is at 6 weeks due, it is recommended to give prophylaxis treatment with lovenox for hellp (hemolysis, elevated liver enzymes, and low platelets).

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case was coded as O09.291 and O34.219 but I don't think this is correct. I think it should be O09.89, O34.219, Z87.89, Z86.718, Z3A.1
I think O09.89 is more appropriate for the pts history of preE and hellp because it wasn't stated that there was a stillbirth or fetal death in the previous pregnancy/delivery. I am also a little bit iffy on O34.219 because the pt is in week 10, she isn't about to go in to labor and O34 seems to be for maternal care just prior to labor? thank you in advance for advice, I am not as comfortable with OB dx coding as I am with other specialties.

 

[nielynco]

Hi, looking for coding advice from an old case:
31-year-old patient here for prenatal visit who brought her baby with her today. The patients last menstrual period was 2/22/2024. She is sure of the dates and states she cycles every 35 days. Her last pregnancy was complicated with preterm delivery and hemolysis, elevated liver enzymes, and low platelets and at 34wks suffered intrauterine growth restriction and postpartum hemorrhage. She delivered by cesarean and states she wants vbac this time (vaginal birth after c-section). Today’s assessment and plan is as follows: pt is at 10 weeks, has a hx of severe preeclampsia and hellp at 34 wks therefore baseline labs ordered. She also has a Hx of postpartum vte (venous thromboembolism). When the patient is at 6 weeks due, it is recommended to give prophylaxis treatment with lovenox for hellp (hemolysis, elevated liver enzymes, and low platelets).

---

case was coded as O09.291 and O34.219 but I don't think this is correct. I think it should be O09.89, O34.219, Z87.89, Z86.718, Z3A.1
I think O09.89 is more appropriate for the pts history of preE and hellp because it wasn't stated that there was a stillbirth or fetal death in the previous pregnancy/delivery. I am also a little bit iffy on O34.219 because the pt is in week 10, she isn't about to go in to labor and O34 seems to be for maternal care just prior to labor? thank you in advance for advice, I am not as comfortable with OB dx coding as I am with other specialties.

While O09.291 can be used for fetal death, the list is not the only things that could be included. But in this case, I think I agree that O09.89 is a better fit for this history. I would not code O34.219 as she is only 10 weeks and her previous cesarean is not yet affecting her management. Once the physician has the VBAC vs. cesarean conversation or she has other complaints that might be linked to this previous delivery, then reporting the code would be appropriate. Right now they are establishing baselines for the previous history. Z87.898 and Z86.781 would also be appropriate (and of course the Z3A.1)