Reimbursement Advisor

Unconfirmed pregnancy: Tips on a new code

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Q When do I use the new diagnosis code V72.40 (Pregnancy examination or test, pregnancy unconfirmed)?

A Use V72.40 only when you have not confirmed that the patient is pregnant at the end of the visit. For example: if a blood specimen was drawn and a serum hCG ordered to confirm pregnancy. Since you would not have results before the patient left, V72.40 is appropriate.

If, on the other hand, a urine color test is performed with a positive result, your diagnosis would be V22.0 or V22.1 (supervision of a normal pregnancy). This is per official ICD-9 guidelines stating that you must code what you know at the end of the visit—unless no problem is found, in which case you can code for symptoms or complaints.

Note, however, that when V codes are used, many payers try to bundle the visit at which pregnancy is diagnosed into the global care. If this happens, try using 626.8 (missed period) for the primary diagnosis on the evaluation and management code, and V22.0 or V22.1 for the urine lab test that confirmed pregnancy.

Ms. Witt, former program manager in the Department of Coding and Nomenclature at the American College of Obstetricians and Gynecologists, is an independent coding and documentation consultant. Reimbursement Adviser reflects the most commonly accepted interpretations of CPT-4 and ICD-9-CM coding. When in doubt on a coding or billing matter, check with your individual payer.

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