by Chris Woolstenhulme, QCC, CMCS, CPC, CMRS
January 20th, 2017
It is important to make a clear distinction between pre-existing conditions and conditions brought on by the pregnancy (gestational) or pregnancy related conditions.
- Condition Detail: Was the condition pre-existing (i.e., present before pregnancy)?
- Trimester: When did the pregnancy-related condition develop?
- Casual Relationship: Establish the relationship between the pregnancy and the complication (e.g., preeclampsia).
- O99.011 Anemia complicating pregnancy, first trimester
- O13.2 Gestational [pregnancy-induced] hypertension without significant proteinuria, second trimester
- O24.012 Pre-existing diabetes mellitus, type 1, in pregnancy, second trimester
- O10.02 Pre-existing essential hypertension complicating childbirth
- O21.2 Late vomiting of pregnancy - Excessive vomiting starting after 20 completed weeks of gestation
Be sure to look for coding notes. "Use additional code," for example, requires you report a code from I15- to identify the type of secondary hypertension. If the patient has pre-existing diabetes mellitus, identify any insulin use (Z79.4). Do not use this code if the patient has gestational diabetes, as this code is for long-term use.
Take a look at another example of a pre-existing condition and the notes associated with this code:
O34.41 Maternal care for other abnormalities of cervix, first trimester
- Includes: the listed conditions as a reason for hospitalization or other obstetric care of the mother, or for cesarean delivery before onset of labor
- Code First: any associated obstructed labor (O65.5)
- Use Additional Code: for specific condition
These instructions are not optional. They must be included in your documentation and coding to ensure proper reimbursement.