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Not sure how to code this...

  1. #11
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    Medical Coding Books
    Quote Originally Posted by babierman View Post
    Yes, I realize that a UTI would be assumed a complication of pregnancy, however, not a single one of our physicians considered it a complication of pregnancy so it could never be coded as that. It had to be coded as a condition affecting the management of the mother. We rarely ever used 646.8X for complications. We code by documentation only from the physician and patient charts and if it wasn't documented as complication- then it wasn't.

    "The same principle applies if the patient had a urinary tract infection (UTI), which is common in pregnancy. If the physician considered the UTI as unrelated to the pregnancy, the visit would be billed at the appropriate E/M level for an established patient (99211-99215), linked to diagnostic codes 599.0 (urinary tract infection, site not specified) and V22.2." This is how we coded. And not only that but it changes the billing guidelines with OB Global- if it's not related, it can be billed out as a separate charge unrelated to the pregnancy.
    The point is that you can code the unrelated UTI in the pregnant patient as long as the physician has stated in the record that the condition is not affecting the pregnancy. It is all about the documentation, not the intention. If the physician did not state that the UTI is not affecting the pregnancy, then correct coding rules state you must use 646.6x. This is one area of ICD-9 coding that is different, you cannot assume the condition is not a complication, the documentation must state it. This is in the ICD-9 Official Guidelines for Coding and Reporting on page 14 in the front of the book.
    Arlene J. Smith, CPC, CPMA, CEMC, COBGC

  2. #12
    Talking
    I'm not trying to disrespect you- clearly we both have misunderstood something at some point- I said my physician doesn't document and according to the guidelines you are referring to- "Obstetric cases require codes from chapter 11, codes in the range 630-679, Complications of Pregnancy, Childbirth, and the Puerperium. Chapter 11 codes have sequencing priority over codes from other chapters. Additional codes from other chapters may be used in conjunction with chapter 11 codes to further specify conditions. Should the provider document that the pregnancy is incidental to the encounter, then code V22.2 should be used in place of any chapter 11 codes. It is the provider's responsibility to state that the condition being treated is not affecting the pregnancy." it doesn't tell me that I have to assume its a complication. I was under the impression that it must be stated that the condition is complicating the pregnancy, and if it's not I revert to section E or the little e: under Current Conditions Complicating to Pregnancy- Assign a code from subcategory 648.X for patients that have current conditions when the condition affects the management of the pregnancy, childbirth, or the puerperium. Use additional secondary codes from other chapters to identify the conditions, as appropriate.

    It is the provider's responsibility to state that the condition being treated is not affecting the pregnancy. If the physician doesn't state the condition is affecting the pregnancy, then why would I assume its a complication? Wouldn't I have to assume he'd need to state its a complication as well? I assumed this statement went with the sentence prior with V22.2 guidelines.

    Anyhow, either way, coding is open to interpretation and its always good to see other view points. I don't believe one way is wrong over the other. I've only been doing this for 8 years and I know every day is a learning experience in coding world.


    Brooke Bierman, CPC, CPB
    Coding & Billing Manager
    2014 President AAPC Des Moines Chapter

  3. #13
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    Tacoma, WA
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    Quote Originally Posted by babierman View Post
    I'm not trying to disrespect you- clearly we both have misunderstood something at some point- I said my physician doesn't document and according to the guidelines you are referring to- "Obstetric cases require codes from chapter 11, codes in the range 630-679, Complications of Pregnancy, Childbirth, and the Puerperium. Chapter 11 codes have sequencing priority over codes from other chapters. Additional codes from other chapters may be used in conjunction with chapter 11 codes to further specify conditions. Should the provider document that the pregnancy is incidental to the encounter, then code V22.2 should be used in place of any chapter 11 codes. It is the provider's responsibility to state that the condition being treated is not affecting the pregnancy." it doesn't tell me that I have to assume its a complication. I was under the impression that it must be stated that the condition is complicating the pregnancy, and if it's not I revert to section E or the little e: under Current Conditions Complicating to Pregnancy- Assign a code from subcategory 648.X for patients that have current conditions when the condition affects the management of the pregnancy, childbirth, or the puerperium. Use additional secondary codes from other chapters to identify the conditions, as appropriate.

    It is the provider's responsibility to state that the condition being treated is not affecting the pregnancy. If the physician doesn't state the condition is affecting the pregnancy, then why would I assume its a complication? Wouldn't I have to assume he'd need to state its a complication as well? I assumed this statement went with the sentence prior with V22.2 guidelines.

    Anyhow, either way, coding is open to interpretation and its always good to see other view points. I don't believe one way is wrong over the other. I've only been doing this for 8 years and I know every day is a learning experience in coding world.
    You are right...it is a learning experience. I learn something new everyday. The rule regarding ICD-9 coding for OB I learned from an AAPC sponsored OB/Gyn seminar a long time ago and it was backed up when the question came up in the Specialty exam I took for my credential. Maybe there are other interpretations...
    Arlene J. Smith, CPC, CPMA, CEMC, COBGC

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