Codapedia is now a division of Find-A-Code

Pre-Existing or Gestational?

February 1st, 2018 - Chris Woolstenhulme, QCC, CMCS, CPC, CMRS
Categories:   Diagnosis Coding   Obstetrics|Gynecology   Primary Care|Family Care  
0 Votes - Sign in to vote or comment.

It is important to make a clear distinction between pre-existing conditions and conditions brought on by the pregnancy (gestational) or pregnancy related conditions.

  1. Condition Detail: Was the condition pre-existing (i.e., present before pregnancy)?
  2. Trimester: When did the pregnancy-related condition develop?
  3. Casual Relationship: Establish the relationship between the pregnancy and the complication (e.g., preeclampsia)

Code examples:

Be sure to look for coding notes. "Use additional code," for example, requires you report a code from I15- to identify the type of secondary hypertension. If the patient has pre-existing diabetes mellitus, identify any insulin use (Z79.4). Do not use this code if the patient has gestational diabetes, as this code is for long-term use.

Take a look at another example of a pre-existing condition and the notes associated with this code:

O34.41 Maternal care for other abnormalities of cervix, first trimester

These instructions are not optional. They must be included in your documentation and coding to ensure proper reimbursement. 

###

Questions, comments?

If you have questions or comments about this article please contact us.  Comments that provide additional related information may be added here by our Editors.


Latest articles:  (any category)

New Modifiers Released in 2018
February 13th, 2018 - Chris Woolstenhulme, QCC, CMCS, CPC, CMRS
There were 13 new modifiers released in 2018, be sure you are using them if appropriate.     FY X-ray taken using computed radiography technology/cassette-based imaging    JG Drug or biological acquired with 340b drug pricing program discount    QQ Ordering professional consulted a qualified clinical decision support mechanism for this service and the related data was ...
Payment Rates Increase for Behavioral Health Office Services
February 13th, 2018 - Wyn Staheli, Director of Research
Behavioral health providers may see some improvement in payment rates for office-based behavioral health services. This is due to the fact that the overhead expense evaluation portion of the RVU was increased. The following information is from the Federal Register (see References): We agree with these stakeholders that the site of service ...
Medicare Requiring Modifier GP on Physical Therapy Services
February 1st, 2018 - Wyn Staheli, Director of Research
Medicare's MLN Matters Number: MM10176 was recently revised to identify services subject to their therapy cap. The revision became effective on January 1, 2018 and some providers have begun to receive claim rejections because they are not using the appropriate modifier. The article states the following (emphasis added): Services furnished under the Outpatient ...
Pre-Existing or Gestational?
February 1st, 2018 - Chris Woolstenhulme, QCC, CMCS, CPC, CMRS
It is important to make a clear distinction between pre-existing conditions and conditions brought on by the pregnancy (gestational) or pregnancy related conditions. Condition Detail: Was the condition pre-existing (i.e., present before pregnancy)? Trimester: When did the pregnancy-related condition develop? Casual Relationship: Establish the relationship between the pregnancy and the complication (e.g., preeclampsia) Code examples: O99.011 Anemia ...
Are Your Computers Vulnerable to Cyber Attacks?
February 1st, 2018 - Wyn Staheli, Director of Research
Healthcare providers must be vigilant in ensuring that software upgrades, also known as patches, are kept current. Failure to do so can lead to a HIPAA Security Breach with all its associated penalties. For example Windows XP no longer has security updates and should not be used in healthcare settings. On ...
Don’t Be Hesitant About Collecting Co-Pays
February 1st, 2018 - Christine Taxin
If you are hesitant about collecting co-pays, consider that you may be paying interest on credit cards, property mortgages, and business loans. Each dollar that you do not collect in co-pays could have been used to pay down the practice debt. Without question, if you are having difficulty finding ways ...
Important CDI and Coding Updates
February 1st, 2018 - Richard Pinson, MD, FACP, CCS, and Cynthia Tang, RHIA, CCS
COPD and Pneumonia The requirement for code J44.0 (chronic obstructive pulmonary disease with acute lower respiratory infection) to be coded first when a patient has pneumonia and COPD has been eliminated as of October 1. The 2018 version of ICD-10-CM replaced the "use additional code" with "code also." According...



About Codapedia & Find-A-Code Contact Us Terms of Use Privacy Policy Advertise with Us

Codapedia™/Find-A-Code™ - 62 E 300 North, Spanish Fork, UT 84660 - Phone 801-770-4203 (9-5 Mountain) - Fax (801) 770-4428

Copyright © 2009-2018 Find A Code, LLC - CPT® copyright American Medical Association