How to Bill and Code for Pre-eclampsia

by | Published on Aug 1, 2023 | Specialty Practices

Bill and Code for Pre-eclampsia
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Expert medical billing and coding support can make a significant difference when it comes to hospital revenue cycle management. When considering pregnancy-associated conditions such as pre-eclampsia, it is important to understand the coding guidelines to assign the correct codes for billing and reimbursement purposes. Healthcare practices can rely on medical billing outsourcing companies that have professional teams to help hospitalists ensure that all services are billed using the correct codes.

Moreover, if the documentation is conflicting, incomplete or inconsistent, expert coders will query the physician to assign the most appropriate codes, which is crucial for accurate reimbursements. In this post, we look at the specifics of medical billing and coding for pre-eclampsia – a serious gynaecology condition.

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What Causes Pre-eclampsia?

Reports suggest that pre-eclampsia tend to affect more than 10 percent of the pregnancies worldwide. Furthermore, it is a leading cause of maternal and infant mortality, with about 76,000 maternal deaths and 500,000 infant deaths each year worldwide. Pre-eclampsia occurs when there is high blood pressure and possibly protein in the urine during pregnancy or after delivery. Typically, this condition may appear after the 20th week of pregnancy. However, it can also occur earlier or after delivery.

Additionally, there is no specific factor that can cause preeclampsia. However, several factors such as – being pregnant with multiple fetuses, autoimmune disorders, blood vessel problems, being pregnant after the age of 36 years, obesity, having a history of high blood pressure/diabetes/kidney disorders and genetic issues can contribute towards this condition.

As the condition progresses, there could be a rise in blood pressure, and protein may suddenly build up in the urine. The patient may also experience certain other symptoms such as – fluid retention (with swelling in the hands, feet, ankles, and face), headache, nausea and vomiting, upper abdominal pain, blurred vision, impaired liver function, and shortness of breath (caused by fluid in the lungs).

If left untreated, the condition can develop into eclampsia – a more serious condition that can cause complications for both the mother and the child. Moreover, there is no specific way to prevent this condition. However, timely screening and early diagnosis can help take preventive actions and avoid complications at the time of pregnancy. Generally, the most recommended treatment for this condition during pregnancy is delivery of the baby. Once the baby is delivered, preeclampsia symptoms tend to resolve and this prevents the disease from progressing. Medications such as antihypertensives, anticonvulsants and corticosteroids may be prescribed.

Medical Codes for Pre-eclampsia

Obstetrics and gynecology medical coding is a complex procedure. Notably, Obstetric gynecologists or other specialists treating pre-eclampsia patients can depend on the services of professional medical billing companies for correct clinical documentation of this condition.

ICD-10 Codes

  • O14 Pre-eclampsia
  • O14.0 Mild to moderate pre-eclampsia
    • O14.00 …… unspecified trimester
    • O14.02 …… second trimester
    • O14.03 …… third trimester
    • O14.04 …… complicating childbirth
    • O14.05 …… complicating the puerperium
  • O14.1 Severe pre-eclampsia
    • O14.10 …… unspecified trimester
    • O14.12 …… second trimester
    • O14.13 …… third trimester
    • O14.14 …… complicating childbirth
    • O14.15 …… complicating the puerperium
  • O14.2 HELLP syndrome
    • O14.20 …… (HELLP), unspecified trimester
    • O14.22 …… (HELLP), second trimester
    • O14.23 …… (HELLP), third trimester
    • O14.24 …… complicating childbirth
    • O14.25 …… complicating the puerperium
    • O14.9 Unspecified pre-eclampsia
      • O14.90 …… unspecified trimester
      • O14.92 …… second trimester
      • O14.93 …… third trimester
      • O14.94 …… complicating childbirth
      • O14.95 …… complicating the puerperium

Here are some specific coding guidelines for pre-eclampsia –

      • Code Selection – The primary code for pre-eclampsia is O14 (Pre-eclampsia), which should be used as the main diagnosis code. The fourth character of the O14 code provides additional information on the severity and complications associated with pre-eclampsia. The available codes are –
        • O14.0: Mild to moderate pre-eclampsia
        • O14.1: Severe pre-eclampsia
        • O14.9: Unspecified pre-eclampsia
      • Additional Codes – If there are specific complications associated with pre-eclampsia, such as renal dysfunction, hepatic involvement, or other organ system involvement, additional codes should be used to capture those conditions. Use additional codes to indicate any coexisting conditions, such as chronic hypertension or diabetes, which may impact the management and treatment.
      • Documentation – Accurate and detailed documentation is essential for proper coding. The medical record should clearly state the diagnosis of pre-eclampsia, the severity if known, and any associated complications. It is important to document any relevant details about the patient’s condition, including laboratory findings, blood pressure readings, symptoms, and treatment provided.
      • Follow Payer-specific Guidelines – It is important to note that different payers may have specific guidelines or requirements for coding pre-eclampsia. Healthcare professionals must familiarize themselves with the coding and billing guidelines of the relevant insurance companies to ensure compliance and proper reimbursement.

CPT Codes

      • 59425 Under Vaginal Delivery, Antepartum and Postpartum Care Procedures (Antepartum care only for a high-risk pregnancy, typically associated with conditions like pre-eclampsia. This code covers the regular antepartum visits, including history, physical examination, and counselling)
      • 59426 Under Vaginal Delivery, Antepartum and Postpartum Care Procedures (Antepartum care only for a high-risk pregnancy requiring additional services, such as more frequent visits, additional laboratory tests, or monitoring. This code is often used for pre-eclampsia cases that require closer monitoring and more intensive management)
      • 59430 Under Vaginal Delivery, Antepartum and Postpartum Care Procedures (Postpartum care only for a high-risk pregnancy, including follow-up visits after delivery. This code can be used when managing postpartum complications associated with pre-eclampsia)
      • 76805 Under Diagnostic Ultrasound Procedures of the Pelvis Obstetrical (Ultrasound examination of pregnant uterus, typically performed to assess fetal growth and well-being. This code may be used when ultrasound is performed to monitor the impact of pre-eclampsia on the fetus)

The specific CPT code selection depends on the documentation of the healthcare provider, the services provided, and the medical necessity of each case.

By partnering with an obstetrics and gynecology medical billing company, healthcare practices can ensure precise billing and coding, as well as prompt submission of claims. Outsourcing these critical tasks enables healthcare providers to prioritize patient care while guaranteeing accurate and timely reimbursement for their services.

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Loralee Kapp

Since joining our RCM Division in October 2021, Loralee, who is HIT Certified (Health Information Technology/Health Information Management), brings her extensive expertise in medical coding and Health Information Management practices to OSI.

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