Physician Practice

Q&A: Answering common questions for OB coding in ICD-10-CM

Physician Practice Insider, November 17, 2015

Q: Do we have to put the ICD-10-CM Z3A.- weeks of gestation codes on every single encounter for OB patients?

A: According to the American Health Information Management Association, the Z3A.- weeks of gestation codes do not have to be appended at every single encounter. However this provides an amazing amount of information and data tracking, not only for your office, but also as transparency for the patient, the payer, and the physician. It is incredibly helpful to see that the patient had her first-trimester ultrasound at 11 weeks, just by reviewing the claim and/or patient data.

Q: In ICD-10-CM, can you bill codes O35.5- (maternal care for [suspected] damage to fetus by drugs) and O99.33- (smoking [tobacco] complicating pregnancy, childbirth, and the puerperium) at the same encounter? What about code O99.32- (drug use complicating pregnancy, childbirth, and the puerperium)?

A: In ICD-10-CM, as with all coding, pay close attention to what the code is actually stating and look at the key verbiage within the code set.

Code O35.5- denotes that the provider is concerned with care provided to the mom, due to “suspected” damage to the fetus from drugs (e.g., the provider may need the mom to have a higher-intensity ultrasound of the fetus or have alternative prescription or social work intervention for a suspected issue with the fetus). Code O99.33- is for use when the provider specifically notes that the mother’s use of tobacco is complicating her pregnancy care and oversight. Code O99.32- is for use when drug usage by the mother (this can be any type of drug, e.g., prescription necessitated, over the counter, herbal, legal, illegal) is complicating the pregnancy care.

All three of these codes can be coded together, however, when coding O35.5- the provider is required to document the suspicion that there may be damage to the fetus from the usage of a particular drug (e.g., the patient is pregnant and currently prescribed drugs for a seizure disorder that may be harmful to a fetus).

Editor’s note: Lori-Lynne A. Webb, CPC, CCS-P, CCP, CHDA, CDIP, COBGC, AHIMA-approved ICD-10-CM/PCS trainer, is an E/M and procedure-based coding, compliance, data charge entry, and HIPAA privacy specialist, with more than 20 years of experience. Lori-Lynne’s coding specialty is OB/GYN office/hospitalist services, maternal fetal medicine, OB/GYN oncology, urology, and general surgical coding. This article originally appeared in Just Coding.

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