Q&A Coding Pregnancy

[Sara Gomez]

Hello all:
I would like to ask about when to code a pregnancy chapter 11 code.
Do you code chapter 11 when the person is pregnant? Or if there is a complication in their pregnancy? I am confused about when to apply this code. Let's say when patient has diagnosed as anemic. Do you start using the 648.2X since patient is pregnant, or do you continue using 280.xx diagnosis? Please help!!

 

[Lori Woods]

Pregnancy Chapter 11 codes always takes sequencing priority over codes from other chapters. You would code the complication if it affected the pregnancy. Any condition that occurs during pregnancy. childbirth, or the puerperium is considered to be a complication unless the attending physician specifically documents that it neither affects the pregnancy nor is affected by the pregnancy, then you would code V22.2. CCO has this video https://www.cco.us/pregnancy-codes/

 

[Sara Gomez]

But what I am wondering is when do those codes start coming into the chart? Say the pt is anemic, but later on after a few visits she then comes to find out she's pregnant(different encounter) and so is still anemic, so is that when the chapter 11 codes is priority from other condition codes. Replace 280.xx with 648.2x???

Or do we use the chapter 11 codes only when the provider documents that anemia is complicating pregnancy so then you would use 648.2x? I don't understand when to start using chapter 11 codes.

When does the chapter 11 code start coming into play to code onto the claim? That is where I am getting more confused on and now am seeing why pregnancy coders get paid more. >>whew! <<

 

[Luna]

My reasoning is:
ICD-9 guideline Chapter 11:e may apply to your question. The woman is anemic and was before the pregnancy. Anemia is a condition that can affect the management of the pregnancy. It may be that she is not currently manifesting any complications with it, but the fact that she is anemic will have a bearing on managing her pregnancy, and childbirth. Medication or supplements (if on any) for her anemia may need adjustment, or she'll be monitored more closely because of her anemia if she experiences fatigue/weakness. With anemia, you have a pregnancy that can affect the anemia, and you have anemia that can affect the pregnancy.

The guideline states: Assign a code from subcategory 648.x for patients who 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.

So, in this case you would code 648.2x Anemia. And then your 280.xx code with it. Why the two codes? Why does the chapter 11 complication code need to be followed with another code? Does it not already suggest the patient has anemia?

Now we have the picture of a pregnant woman with anemia with the first code, and what kind of anemia with the second code.

 

[Sara Gomez]

Thank you, Luna. I really appreciate your time in this feed back. It provided more of a perspective and how I need to look at the document to relay into codes for the whole story.