October 2011

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Gestational Diabetes

By Judy Bielby, MBA, RHIA, CPHQ, CCS

Objective:  To discuss coding for gestational diabetes.

Coding scenarios: Patient A is 30 weeks pregnant and is seen for treatment of gestational diabetes. Patient B is seen for diabetes screening. Patient B is not currently pregnant, does not currently have a diagnosis of diabetes, nor does she exhibit signs or symptoms of diabetes, but she does have a history of gestational diabetes with a previous pregnancy.

ICD-9-CM Codes assigned:

Patient A – 648.83, Abnormal glucose tolerance in mother complicating pregnancy, antepartum
Patient B – V77.1, Special screening for diabetes mellitus; V12.21, Personal history of gestational diabetes

Coding Conventions and/or Guidelines Involved

ICD-9-CM Official Guidelines for Coding and Reporting, I.C.11.g and I.C.18.d5

  1. I.C.11.g Gestational diabetes
    Gestational diabetes can occur during the second and third trimester of pregnancy in women who were not diabetic prior to pregnancy. Gestational diabetes can cause complications in the pregnancy similar to those of pre-existing diabetes mellitus. It also puts the woman at greater risk of developing diabetes after the pregnancy. Gestational diabetes is coded to 648.8x, Abnormal glucose tolerance. Codes 648.0x and 648.8x should never be used together on the same record.
  2. Code V58.67, Long-term (current) use of insulin, should also be assigned if the gestational diabetes is being treated with insulin.

I.C.18.d5 Screening
Screening is the testing for disease or disease precursors in seemingly well individuals so that early detection and treatment can be provided for those who test positive for the disease. Screenings that are recommended for many subgroups in a population include: routine mammograms for women over 40, a fecal occult blood test for everyone over 50, an amniocentesis to rule out a fetal anomaly for pregnant women over 35, because the incidence of breast cancer and colon cancer in these subgroups is higher than in the general population, as is the incidence of Down’s syndrome in older mothers.

The testing of a person to rule out or confirm a suspected diagnosis because the patient has some sign or symptom is a diagnostic examination, not a screening. In these cases, the sign or symptom is used to explain the reason for the test.

A screening code may be a first listed code if the reason for the visit is specifically the screening exam. It may also be used as an additional code if the screening is done during an office visit for other health problems. A screening code is not necessary if the screening is inherent to a routine examination, such as a pap smear done during a routine pelvic examination.

Should a condition be discovered during the screening then the code for the condition may be assigned as an additional diagnosis.

The V code indicates that a screening exam is planned. A procedure code is required to confirm that the screening was performed.

The screening V code categories:
V28 Antenatal screening
V73-V82 Special screening examinations

References and Helpful Web Sites:

Centers for Medicare and Medicaid Services. Preventive Benefits Overview.

Endicott, Melanie. "New ICD-9-CM Diagnosis Codes for FY 2012." Journal of AHIMA 82, no.9 (September 2011): 60-62.

National Center for Health Statistics. ICD-9-CM Coordination and Maintenance Committee Conference Call Transcript, (September 16, 2010), p.29.

National Center for Health Statistics. ICD-9-CM Official Guidelines for Coding and Reporting (October 1, 2010).

National Institute of Child Health & Human Development. “Gestational Diabetes.” (April 29, 2008).

WebMD. “Pregnancy and Gestational Diabetes Screening.” “Health and Pregnancy Guide.” (December 20, 2009).

Judy Bielby is a clinical assistant professor at the University of Kansas and a consultant with Durst & Associates in the Kansas City area.

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