The new BMI codes (V85.0–V85.4) are reported for any adult older than 20. Next year, codes will be added for patients who are between 2 and 20 years of age.
MULTIPLE GESTATION
CODING DILEMMA
Should a pregnancy be coded differently after a fetal reduction procedure?
Mariana, 40, undergoes in vitro fertilization with implantation of 2 embryos, but later, because of her age and health (she has metabolic syndrome), requests fetal reduction for a singleton gestation.
Multifetal pregnancy reduction is billed using CPT code 59866, and we now have a new ICD-9-CM code to characterize such gestations after the procedure: 651.7X, multiple gestation following (elective) fetal reduction.
The last digit can be 0, episode of care unspecified; 1, delivered with or without mention of antepartum condition; or 3, antepartum condition or complication.
High risk remains. Though fetal reduction will generally reduce risk to the remaining fetuses, the pregnancy is still considered high-risk. ICD-9-CM staff have clarified that this code should be reported even if, as in Mariana’s case, the pregnancy is reduced to a singleton gestation, as fetal reduction is a complicating factor.
ABNORMAL GLUCOSE TOLERANCE
CODING DILEMMA
Is there a specific code for elevated glucose tolerance test?
At 28 weeks’ gestation, Rebecca reports symptoms suggesting hyperglycemia, so you order blood glucose testing, which reveals elevated glucose tolerance.
Code 648.8X, abnormal glucose tolerance, has been revised to include conditions classifiable as 790.21 through 790.29, and a note was added to report V58.67 for associated long-term (current) insulin use.
Codes 790.21 through 790.29 are used to report specific abnormal glucose findings and may be added as a secondary diagnosis to clarify the abnormal result in pregnancy. For instance, code 790.21 is reported if the patient has elevated fasting glucose, while 790.22 indicates she has an elevated glucose tolerance test, as in Rebecca’s case.
Other pregancy-related codes
Obstructed labor. In other pregnancy-related changes, ICD-9-CM has clarified use of 660.8X, other causes of obstructed labor, to require an additional code to identify the cause. For instance, if the internal orifice is total obstructed by a tumor, use code 660.8X as the primary diagnosis and 653.8X, disproportion of other origin.
Procreative management. V59.7, donor, egg (oocyte) (ovum) has been added, and includes five 5-digit codes for type of donor. Using them properly requires knowing the age and status (eg, anonymous or not) of the donor. If no information about the donor’s age is available, the unspecified code V59.70 is used. Otherwise the choices are V59.71 and V59.73 for anonymous donors under age 35 and 35 and over, respectively, and V59.72 and V59.74 for donors under age 35 and 35 and over, respectively, whose eggs are to go to a designated recipient.
Blood typing. V72.86, encounter for blood typing, now can be used to report testing of the father when the mother is Rh-negative. This information allows physicians to determine the risk of Rh sensitization in the fetus and decide whether immunoglobulin administration is necessary to prevent it during the remainder of the pregnancy.