Health Information Management

Q&A: Coding for diagnosis of pregnancy-elevated primary glucose tolerance test

HIM Connection, August 24, 2010

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Q: Which code should I report for a diagnosis of pregnancy-elevated primary glucose tolerance test? Should I report 790.22 (impaired glucose tolerance test [oral]) or 648.83 (abnormal glucose tolerance, antepartum condition or complication)?

A: Coding Clinic, fourth quarter 2008, pp. 245–252, states:
 
Obstetric cases require codes from chapter 11, codes in the range 630–679, Complications of Pregnancy, Childbirth, and the Puerperium. Chapter 11 codes have sequencing priority over codes from other chapters. Additional codes from other chapters may be used in conjunction with chapter 11 codes to further specify conditions. Should the provider document that the pregnancy is incidental to the encounter, then code V22.2 should be used in place of any chapter 11 codes. It is the provider’s responsibility to state that the condition being treated is not affecting the pregnancy.
 
Section G (Gestational diabetes), p. 47, of the ICD-9-CM Official Guidelines for Coding and Reporting states:
 
Gestational diabetes can occur during the second and third trimester of pregnancy in women who were not diabetic prior to pregnancy. Gestational diabetes can cause complications in the pregnancy similar to those of pre-existing diabetes mellitus. It also puts the woman at greater risk of developing diabetes after the pregnancy. Gestational diabetes coded to 648.8x, Abnormal glucose tolerance. Codes 648.0x and 648.8x should never be used together on the same record. Code V58.67, Long-term (current) use of insulin, should also be assigned if the gestational diabetes is being treated with insulin.
 
Therefore, you should use ICD-9-CM code 648.83.
 
Editor’s note: Sandra Sillman, RHIT, PAHM, DRG coordinator at HenryFord Health System in Detroit, answered this question in the August issue of Briefings on Coding Compliance Strategies.



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