Q&A: Pregnancy Services; Rural Healthcare; Neonatal Care<

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PREGNANCY CONSULTING

Q: I recently consulted with a patient who was wondering whether she should terminate her pregnancy. She was asking for my opinion. I coded ICD-9 648.1 for multiple pregnancies at high age, which was rejected. What is the correct code?

A: According to coding expert Emily Hill of Hill & Associates, ICD code 648.1 is actually under the category of current complications of pregnancy and denotes a thyroid disorder. Any code in the pregnancy section (630-677 or V22 series) would likely cause the payer to include the visit in global maternity care. Since you were not managing pregnancy at this visit, you would not report a pregnancy code. If this had been the visit at which pregnancy was diagnosed, then you could report V72.42. Based on the scenario you described, however, either V26.4 (general counseling and advice) or V26.8 (other specified procreative management) would be the best choices. Be aware that all payers may not cover these services.

GLOBAL DELIVERY SERVICES

Q: We have a question regarding what is included in a global delivery. Does it include 76818 (fetal biophysical profile with non-stress testing) or 76819 (without non-stress testing)?

A: Emily Hill says the global obstetric package includes services normally provided in cases of uncomplicated pregnancy. The introductory language to the codes in CPT describes the typical services included in antepartum, delivery, and postpartum care. Biophysical profiles, when clinically indicated, would be reported in addition to the global code.

MATERNITY CARE

Q: We have a question regarding maternity care. When billing a 59410 (vaginal delivery only, including postpartum care) does the “postpartum care” only refer to visits to the hospital when the physician is doing her rounds, or does it also include the patient visit to the office a few weeks later? Do we bill the office visit separately after delivery?

A: Code 59410 is used only when the obstetrician or group has not provided all of the global maternity care for the patient, advises Emily Hill. The delivery-only codes, such as 59409, include inpatient postpartum care. The postpartum care noted in 59410 includes outpatient postpartum care. Therefore, if you report code 59410, it includes inpatient and outpatient visits. You would not separately report an outpatient postpartum visit when you report 59410.

CODING FOR MUTIPLE PREGNANCIES

Q: When do we use the code V22?

A: According to Emily Hill, V22.0 covers supervision of the patient’s first pregnancy and V22.1 covers supervision of a subsequent pregnancy. These are identified as primary diagnoses in ICD-9.

The codes don’t refer to the number of live births, but rather the number of pregnancies a patient has had. If the patient has never been pregnant, then V22.0 is used. If she has ever been pregnant, whether or not it ended in a live birth, then code V22.1 is used. V22.2 is reported as a secondary diagnosis when the primary reason for the encounter is unrelated to the pregnancy. In that case, the primary reason for the encounter is listed first, and V22.2 is listed second. Be aware that some payers will treat the claim as “related to the pregnancy” if a code in the V22 series is listed anywhere on the claim. Therefore, it may be best to omit V22.2 from the claim and report only the primary reason for the encounter.

NEONATAL CARE

Q: How do I code if a baby needs extra time in the hospital for phototherapy, a circumcision, or to answer a mom’s breast-feeding questions?

A: Emily Hill says that according to the American Academy of Pediatrics publication, Coding for Pediatrics, care for the neonate who is being observed for progression of jaundice, possible late development of signs of infection, or who is recovering from a low Apgar<

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