Home in On the Details in 2018 Ob-gyn Coding

Tue, Nov 21, 2017 --

Coding Updates

Most ob-gyn coders know the mantra—specificity, specificity, specificity. If you want prompt and ethical reimbursement in 2018, though, specificity just got real. Are you up to date on the changes now in effect?

Pick a Side with New Sixth Character for Tubal and Ovarian Pregnancies

CMS provided some much-needed updates to tubal and ovarian pregnancies with and without intrauterine pregnancy. Lateral status, historically absent in the code description, is now indicated in a new sixth character:

Deletion of O00.10 (Tubal pregnancy without intrauterine pregnancy)

  • Addition of O00.101 (Right tubal pregnancy without intrauterine pregnancy)
  • Addition of O00.102 (Left tubal pregnancy without intrauterine pregnancy)
  • Addition of O00.109 (Unspecified tubal pregnancy without intrauterine pregnancy)

Deletion of O00.11 (Tubal pregnancy with intrauterine pregnancy)

  • Addition of O00.111 (Right tubal pregnancy with intrauterine pregnancy)
  • Addition of O00.112 (Left tubal pregnancy with intrauterine pregnancy)
  • Addition of O00.119 (Unspecified tubal pregnancy with intrauterine pregnancy)

Deletion of O00.20 (Ovarian pregnancy without intrauterine pregnancy)

  • Addition of O00.201 (Right ovarian pregnancy without intrauterine pregnancy)
  • Addition of O00.202 (Left ovarian pregnancy without intrauterine pregnancy)
  • Addition of O00.209 (Unspecified ovarian pregnancy without intrauterine pregnancy)

Deletion of O00.21 (Ovarian pregnancy with intrauterine pregnancy)

  • Addition of O00.211 (Right ovarian pregnancy with intrauterine pregnancy)
  • Addition of O00.212 (Left ovarian pregnancy with intrauterine pregnancy)
  • Addition of O00.219 (Unspecified ovarian pregnancy with intrauterine pregnancy)

New Antepartum Maternal Code for Abnormalities of Fetal Heart Rate

Along with the existing code O76 (Abnormality in fetal heart rate and rhythm complicating labor and delivery), you now have the means to report a non-reassuring fetal heart rate or fetal tachycardia or bradycardia during the antepartum period with the new code O36.83- (Maternal care for abnormalities of the fetal heart or rhythm …).

This code comes as a welcomed addition, as fetal heart rate problems during the antepartum period necessitate ongoing monitoring and greater maternal care. In keeping with the 2018 trend, this code, too, requires sixth and seventh characters, which signifies the trimester and number of fetuses, respectively.

Sixth character trimester-specific options: 

  • “1” for first trimester
  • “2” for second trimester
  • “3” for third trimester
  • “9” for unspecified trimester.

Seventh character fetus-specific options: 

  • “0” for a singleton pregnancy or when the number of fetuses is not known
  • “1” for fetus 1
  • “2” for fetus 2
  • “3” for fetus 3
  • “4” for fetus 4
  • “5” for fetus 5
  • “9” for other fetus.

If, for example, you have a third trimester pregnant patient requiring maternal care for abnormalities of fetal heart rate for fetus 3, you will report O36.8333.

Pin Down Antenatal Screening with These New Codes

The catchall code Z36 (Encounter for antenatal screening of mother) is obsolete. We’re getting more specific in 2018 with a host of antenatal screening codes that specify the type of screening performed. These include:

  • 0 (Encounter for antenatal screening for chromosomal anomalies)
  • 1 (… for raised alphafetoprotein level)
  • 2 (Encounter for other antenatal screening follow-up)
  • 3 (Encounter for antenatal screening for malformations)
  • 4 (… for fetal growth retardation)
  • 5 (… for isoimmunization)
  • 81 (… for hydrops fetalis)
  • 82 (… for nuchal translucency)
  • 83 (… for congenital cardiac abnormalities)
  • 84 (… for fetal lung maturity)
  • 85 (… for Streptococcus B)
  • 86 (… for cervical length)
  • 87 (… for uncertain dates)
  • 88 (… for fetal macrosomia)
  • 89 (Encounter for other specified antenatal screening)
  • 8A (Encounter for antenatal screening for other genetic defects)
  • 9 (Encounter for antenatal screening, unspecified).

Remember: Your documentation must capture why the patient underwent this encounter for antenatal screening.

Locate Your Unspecified Lump in the Breast

Reporting an “unspecified lump” code is somewhat rare, as you’ll likely wait for pathology to report your surgeon’s diagnostic and therapeutic breast procedures. For those circumstances, though, that require you to code an “unspecified lump,” N63 (Unspecified lump in breast) will no longer cut it.

2018 brings a fourth and fifth character to the new code N63.0 (Unspecified lump in unspecified breast). The new character options address laterality and breast quadrant:

  • 0 (Unspecified lump in unspecified breast)
  • 1- (Unspecified lump in right breast) and N63.2- (Unspecified lump in left breast) with a fifth character specifying 0 (unspecified quadrant), 1 (upper outer quadrant), 2 (upper inner quadrant), 3 (lower outer quadrant), and 4 (lower inner quadrant).
  • 3- (Unspecified lump in axillary tail) with a fifth character representing 1 (of the right breast) and 2 (of the left breast).
  • 4- (Unspecified lump in breast, subareolar) with the fifth character representing 1 (right) and 2 (left).

Identify Diagnostic or Screening for Post-Hysterectomy Pap Smears

The rules for coding Paps differ for Medicare patients who underwent a hysterectomy due to malignancy. In other words, you should not report Q0091 (Screening Papanicolaou smear; obtaining, preparing and conveyance of cervical or vaginal smear to laboratory) for these patients because this code refers to a screening Pap smear.

Following a hysterectomy to treat cancer, all Paps performed will be diagnostic, not screening. You should report diagnostic, post-cancer Paps with an E/M code (for example, 99213, Office or outpatient visit for the evaluation and management of an established patient …).

Complication: What if the Pap smear is performed several years after the hysterectomy? Could you submit Q0091?

Answer: If the purpose of the E/M visit is to follow up for the patient’s cancer, then the Pap smear remains diagnostic. The ob-gyn can choose to return the patient to the screening group where she will receive screenings every two years, according to Medicare rules. If, however, the physician thinks the patient requires an annual Pap smear, in light of her history, it will have to be a diagnostic service with the collection of the specimen included in the E/M code.

Bottom Line

The addition of these codes enhances the accuracy and specificity of reporting of these conditions. Notice, too, how they underscore the imperative to document key elements to support specificity. Live the mantra—specificity, specificity, specificity.

What About You?

Do you find these new codes beneficial?


Deborah concentrates on coding and compliance for radiology and cardiology, including the tricky world of interventional procedures, as well as oncology and hematology. Since joining The Coding Institute in 2004, she’s also covered the ins and outs of coding for orthopedics, audiology, skilled nursing facilities (SNFs), and more.

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