Pre-Existing or Gestational?

by  Christine Woolstenhulme, QCC, QMCS, 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.

  1. Condition Detail: Was the condition pre-existing (i.e., present before pregnancy)?
  2. Trimester: When did the pregnancy-related condition develop?
  3. Casual Relationship: Establish the relationship between the pregnancy and the complication (e.g., preeclampsia).

Code examples:

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

These instructions are not optional. They must be included in your documentation and coding to ensure proper reimbursement. 

References:

Pre-Existing or Gestational?. (2017, January 20). Find-A-Code Articles. Retrieved from https://www.findacode.com/articles/pre-existing-or-gestational-31574.html

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