Pre-Existing or Gestational?
January 20th, 2017 - Chris Woolstenhulme, 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).
- O99.011 Anemia complicating pregnancy, first trimester
- O13.2 Gestational [pregnancy-induced] hypertension without significant proteinuria, second trimester
- O24.012 Pre-existing diabetes mellitus, type 1, in pregnancy, second trimester
- O10.02 Pre-existing essential hypertension complicating childbirth
- O21.2 Late vomiting of pregnancy - Excessive vomiting starting after 20 completed weeks of gestation
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
- Includes: the listed conditions as a reason for hospitalization or other obstetric care of the mother, or for cesarean delivery before onset of labor
- Code First: any associated obstructed labor (O65.5)
- Use Additional Code: for specific condition
These instructions are not optional. They must be included in your documentation and coding to ensure proper reimbursement.
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.
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