Health Information Management

The panda was faking it

HIM-HIPAA Insider, September 15, 2014

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The truth is often stranger than fiction because fiction has to make sense.

 
Apparently a panda in China figured out that pregnant pandas get better treatment, so she pretended to be expecting.
 
Instead of hearing the pitter-patter of baby panda paws, her keepers discovered they were dealing with a master deceiver.
 
Fake pregnancies do occur in humans, but they are more likely to happen in animals. If we had a patient who was faking a pregnancy, how would we code it?
 
It depends on our patient’s symptoms.
 
A fake pregnancy in humans can be an outright lie, which could mean you are dealing with a patient who suffers from a mental disorder. In those cases, the patient may have a factitious disorder (deliberately and consciously acting as if you have an illness when you aren’t sick).
 
ICD-10-CM includes four code choices for factitious disorder:
  • F68.10, factitious disorder, unspecified
  • F68.11, factitious disorder with predominantly psychological signs and symptoms
  • F68.12, factitious disorder with predominantly physical signs and symptoms
  • F68.13, factitious disorder with combined psychological and physical signs and symptoms
Since the panda in question was only displaying pregnancy behaviors, we would code F68.11.
Sometimes, though, a woman may believe she is pregnant when she’s not. False pregnancy, clinically termed pseudocyesis, is the belief that you are expecting a baby when you are not really carrying a child. In ICD-10-CM, we would report F45.8 (other somatoform disorders).
 
The ICD-10-CM Alphabetic Index includes the term pseudocyesis, but it’s not explicitly listed as one of the included terms under F45.8.
 
Not every physician will diagnose a false pregnancy as pseudocyesis. Instead the physician may simply document the patient’s symptoms, such as lack of appetite, nausea and vomiting, enlarged breasts, milk production, and interruption of the menstrual period.
 
The physician may think the patient is pregnant, but orders a pregnancy test to be sure. If the physician orders a blood test, you won’t know the results when the patient leaves the office after the visit. If the physician documents “possible pregnancy” in the outpatient record, we can’t code pregnancy. We have to code the signs and symptoms.
 
ICD-10-CM includes two possible codes for lack or loss of appetite:
  • R63.0, anorexia (loss of appetite)
  • F50.8, other eating disorders (psychogenic loss of appetite)
For the nausea and vomiting, we would report R11.2 (nausea and vomiting, unspecified).
Make sure you are not coding the conditions separately, since ICD-10-CM also includes these codes:
  • R11.0, nausea
  • R11.10, vomiting
  • R11.11, vomiting without nausea
  • R11.12, projectile vomiting
  • R11.13, vomiting of fecal matter
If our patient is an inpatient, we should know at the time of discharge whether she is pregnant. However, if the physician documents “possible pregnancy” for an inpatient, we would report the pregnancy code as if the pregnancy was confirmed.
 
You should already be used to that distinction because we have the same rule in ICD-9-CM. No coding of possible, probably, suspected, or rule out diagnoses on the outpatient side. On the inpatient side, report them as if they were present.
 
On a happier note, another Chinese panda recently gave birth to triplets. Hopefully, all three will survive.
 
This article originally appeared on HCPro’s ICD-10 Trainer blog.



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