EmailACS 1521 Conditions and injuries in pregnancy - non obstetric conditions in pregnancy
Publication Date: September 2018
ICD 10 AM Edition: Tenth edition
Query Number: 3401
ACS 1521 Conditions and injuries in pregnancy - non obstetric conditions complicating pregnancy states that:
In the absence of specific documentation, a nonobstetric condition is classified as complicating pregnancy as indicated by two or more of the following criteria:
- Patient is admitted to an obstetric unit
- Patient is supervised/evaluated by an obstetrician, midwife and/or neonatologist (Note: evaluation may be performed remotely. That is, the clinician is located in another facility and consults via electronic methods (eg video/telephone conferencing))
- Fetal evaluation and/or monitoring is performed
- Patient is transferred to another facility for obstetric and/or neonatal care (see also ACS 1550 Discharge/transfer in labour).
If a condition is documented as 'not complicating the pregnancy' is it correct to not code this as an obstetric complication even if it meets the criteria above?
For example principal diagnosis on Discharge Summary: Low back pain not complicating pregnancy. During the admission fetal monitoring was performed and the patient was evaluated by an obstetrician but the conclusion was that the low back pain was not related to the pregnancy and not complicating the pregnancy. Should this be coded to M54.5 Low back pain and no codes from Chapter 15 assigned?
Is it considered ethical to query with the clinician whether a condition is 'not complicating the pregnancy' and therefore the coder doesn't have to follow the dot points above?
In the absence of specific documentation, a nonobstetric condition is classified as complicating pregnancy as indicated by two or more of the following criteria:
- Patient is admitted to an obstetric unit
- Patient is supervised/evaluated by an obstetrician, midwife and/or neonatologist (Note: evaluation may be performed remotely. That is, the clinician is located in another facility and consults via electronic methods (eg video/telephone conferencing))
- Fetal evaluation and/or monitoring is performed
- Patient is transferred to another facility for obstetric and/or neonatal care (see also ACS 1550 Discharge/transfer in labour).
If a condition is documented as 'not complicating the pregnancy' is it correct to not code this as an obstetric complication even if it meets the criteria above?
For example principal diagnosis on Discharge Summary: Low back pain not complicating pregnancy. During the admission fetal monitoring was performed and the patient was evaluated by an obstetrician but the conclusion was that the low back pain was not related to the pregnancy and not complicating the pregnancy. Should this be coded to M54.5 Low back pain and no codes from Chapter 15 assigned?
Is it considered ethical to query with the clinician whether a condition is 'not complicating the pregnancy' and therefore the coder doesn't have to follow the dot points above?
Response
The dot point criteria in ACS 1521 Conditions and injuries in pregnancy - Nonobstetric conditions complicating pregnancy are to be used in the absence of specific documentation. If a condition is documented as 'not complicating the pregnancy' it should not be coded as an obstetric complication.
In the scenario provided, the principal diagnosis was low back pain not complicating the pregnancy. The diagnosis has been specifically documented as not complicating the pregnancy, therefore M54.5 Low back pain should be assigned rather than codes from Chapter 15 . This is regardless of fetal monitoring and evaluation by an obstetrician.
In regard to the last question about whether it is considered ethical to query with the clinician whether a condition is 'not complicating the pregnancy', unlike some other standards, ACS 1521 does not specifically instruct the coder to seek clarification from the clinician is as it is clear about what to do in the absence of specific documentation of 'not complicating pregnancy'. Therefore VICC does not consider it necessary to query whether a condition is 'not complicating pregnancy' with the clinician.
In the scenario provided, the principal diagnosis was low back pain not complicating the pregnancy. The diagnosis has been specifically documented as not complicating the pregnancy, therefore M54.5 Low back pain should be assigned rather than codes from Chapter 15 . This is regardless of fetal monitoring and evaluation by an obstetrician.
In regard to the last question about whether it is considered ethical to query with the clinician whether a condition is 'not complicating the pregnancy', unlike some other standards, ACS 1521 does not specifically instruct the coder to seek clarification from the clinician is as it is clear about what to do in the absence of specific documentation of 'not complicating pregnancy'. Therefore VICC does not consider it necessary to query whether a condition is 'not complicating pregnancy' with the clinician.
