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Ob-Gyn Coding Alert

Correctly Assigning V Codes or Five-Digit Ob Diagnosis Codes Optimizes Reimbursement

"The ICD-9 manual has two separate sections of diagnostic codes for pregnancy. Understanding when to apply which codes can be the key to greater reimbursement for the supervision of high-risk or otherwise complicated pregnancies.

By simplest definition, V codes are used for the supervision of a normal pregnancy, or the supervision of a high-risk pregnancy when no complications occur. Specifically, codes V22.0 (supervision of first normal pregnancy) or V22.1 (supervision of other normal pregnancy) are about as basic a diagnosis code as you can get for pregnancy.

Other pregnancies, although considered high risk because of potential problems due to the mothers age or reproductive history, for example, are coded as high risk but frequently progress to term with no complications. These circumstances are coded using the V23 (supervision of high-risk pregnancy) family of codes. This category includes codes such as: V23.0 (pregnancy with history of infertility) or V23.81 (elderly primigravida; first pregnancy in a woman who will be 35 years of age or older at expected date of delivery).

High-risk pregnancy codes dont imply that the patient has a problem, says Susan Callaway-Stradley, CPC, CCS-P, an independent coding consultant and educator based in North Augusta, S.C. It only means there is a greater potential for problems. If a high-risk pregnancy progresses satisfactorily, the V code is the only diagnostic code required. For instance, V23.81 is the code for an elderly primigravida. The code alone doesnt imply there are complications in the pregnancy, but it does mean you have to monitor the patient more closely than you might a younger ob patient. Callaway-Stradley says that using the high-risk diagnosis code will help justify any additional visits or screening tests that occur during the pregnancy. For instance, she says, almost every elderly primigravida undergoes an amniocentesis. In most cases, insurers will see that high-risk code, see the code for the amnio and put two and two together, where they might have otherwise balked at paying for an amnio.

When Does High Risk Become Complicated?

The five-digit diagnostic codes come into play in one of two ways: Either the patient presents with a complicating problema history of hypertension or pre-existing diabetes, for instanceor she develops complications during the course of the pregnancy. In this case, its time to turn to the five-digit complications of pregnancy section of the ICD-9 book, which starts with code 634.xx and continues through to code 676.xx.

Just about anything that can happen to a human being [during pregnancy and delivery] is in that coding chapter, says Angela Wood, CPC, CCS, a healthcare consultant [...]