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Thread: abdominal pain and pregnancy in ED

  1. #1

    Default abdominal pain and pregnancy in ED

    AAPC: Back to School
    What dx will be for pt with abdominal pain and pragnant in ED, where can I find more info about that ?

  2. #2


    789.00 abdominal pain unspecified site and v22.2 pregnant state,incidental.

  3. #3


    I disagree. I believe that should be coded 648.93 current condition in mother comlicating pregnancy, antepartum and 789.00 abdominal pain, unspecified site. Unless the physician specifies that the pregnancy is incidental to the reason for the visit (abdominal pain). Here is the official coding guideline on this subject:

    ICD-9-CM Official Guidelines For Coding And Reporting
    Effective November 15, 2006

    The guidelines include the updated V Code Table

    11. Chapter 11: Complications Of Pregnancy, Childbirth, And The Puerperium (630-677)

    a. General Rules For Obstetric Cases

    1) Codes from chapter 11 and sequencing priority

    Obstetric cases require codes from chapter 11, codes in the range 630-677, 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.

  4. #4
    Join Date
    Apr 2007
    San Diego, California


    I agree with using a chapter 11 code if possible. I always have trouble with 648.9X because the ICD book states which corresponding illness codes are covered by 648.9X. 789.00 is not in that range of codes. So, you either have to disregard the list of corresponding codes, or you have to "misuse" V22.2. Hopefully ICD-10 will have better coverage of conditions during pregnancy.

  5. #5


    This very scenario is addressed in the ED Practicum for the CEDC. Code 646.83, 789.00.

    V22.2 is only used when the provider documents that the condition being treated is not affecting the pregnancy.

    The Ingenix Expert ICD-9 has a Resources section in the back for pregnancy codes (at least 2010 has it, I have the AAPC ICD-9 for 2011). Under antepartum, pains 646.83 is listed with a note to assign an additional code to describe the condition.

  6. #6


    100000% agree with mojo and whomever said to misuse the V22.2.. that is just plain insane. You can't just use V22.2 because you are unsure of the proper complication of pregnancy code. Heck, you can't just use any code period because you couldn't find or didn't want to take the time to find the code. Why even bother coding then? We are held to a HIGH standard. Using a code just because you can't find another (and knowing it is wrong) is well below any standard. Just my two cents.

  7. #7
    Join Date
    Apr 2007
    Johnstown, Pennsylvania Chapter


    I also agree with Mojo. That is how it should be coded.

  8. #8
    Join Date
    Apr 2007
    Hartford, CT

    Default Re: abdomen pain and pregnancy in the ED

    it depends on what discipline you were taught in, AAPC seems to teach to use the incidental v code and Ahima will tell you to always use a comp code unless the provider indicates in documentation that the pregnancy is incidental to what the patient is being treated for. i always use the comp code for pregnancy .
    Pat A. Trautner, CCS/CPC/CEDC/CHONC

  9. #9
    Join Date
    Apr 2007

    Exclamation Help with CPT suggestion

    I know this is an late entry but, I had to code a similar situation as follows: The pt came to the emergency dept because she had injured her big toe. The ED physician diagnosis was sprain of the first digit left foot. Althought it was documented in the chief complaint that the pt was pregnant, the ED physician did not address the pregnancy.

    Correct me if I am wrong however, all the documentation was addressing the the sprained toe with no further mention of the pregnancy. I think this qualifies for use of V22.2 for the pregnancy state instead of an pregenancy complication code.

    Just my late 1 1/2 cents


  10. #10
    Join Date
    Apr 2007
    Columbia, MO


    Just because the pregnancy was not overtly addressed in the treatment and assessment it was taken into consideration when they decided on the treatment. You cannot use V22.2 without specific documentation as MOJO and others have stated. You may think it qualifies as a V22.2 but the provider did not document for that code therefore we must code as MOJO has directed, there is no other choice.

    Debra A. Mitchell, MSPH, CPC-H

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