Pregnancy icd codes V22.0, V22.1 and V22.2

Coding of pregnancy charts is little tricky. When coders get OB chart they we mostly get confuse with the cpt as well as with icd codes. Since, we have different chapter 11, especially for OB complication codes. Therefore, whenever we have an OB procedure performed with a complication we have to code icd 9 diagnosis from the chapter 11 codes.  In addition, we are having some V codes used during the coding of OB charts.  Many have confusion when to codes these V codes while coding OB or Non-OB chart.

V22.0- Supervision of first pregnancy

V22.1- Supervision of other normal pregnancy

V22.2- Pregnancy state incidental

The first two V codes are used very frequently for coding OB charts.

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Difference between V22.0 and V22.1

These two codes are very similar in meaning but a slight difference. V22.0 is used when there is supervision of first pregnancy of the patient is documented in the OB charts. V22.1 is used when the supervision is for other than first pregnancy like second, third etc. Hence, whenever the physician documents the patient is not having complication and is just come for the normal checkup during pregnancy, we use V22.0 or V22.1. Do not use them when the physicians document any complication like hemorrhage in the OB chart. Since, the complication will lead to chapter 11 codes and presence of these codes cannot keep this visit normal. Therefore, we should report V22.0 or V22.1, along with chapter 11 codes.

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ICD 10 codes for V 22.0, V22.1 and V22.2

In ICD 10 we have specific codes for specific trimester. For first, second and third trimester we have specific ICD 10 codes for visit for supervision of normal or incidental pregnancy. For example, for unspecified trimester also we have separate code, below are the specific ICD 10 codes for unspecified trimester

Z34.00-  Encounter for supervision of normal first pregnancy, unspecified trimester

Difference between V22.0, V22.1 with V22.2

Suppose the patient has a problem, which is not related pregnancy. So, while reporting the diagnosis we are suppose use normal codes, along with V22.2 instead of coding chapter 11 codes. However, the physician should clearly document that the diagnosis is not affecting the pregnancy and the pregnancy is incidental.  For example, a patient is coming with headache and is 16 weeks pregnant, the physician documents that the headache is not related to pregnancy, so in such situation we have to use normal 784.0 as primary code, since the patient is coming with this problem, followed by V22.2. Here, we are not using any chapter 11 code and we are coding V22.2, since the pregnancy is considered as incidental because the problem (headache) is not related to pregnancy. This visit should not be a part of prenatal care.

If the patient is coming with headache in prenatal routine visit, the code will vary. The headache, which is unrelated to pregnancy, will be followed by V22.0 for first pregnancy or V22.1 for other normal pregnancy.

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Do and Don’t

Do not code V22.2 with OB CPT codes like 76801, 76815, 76817 etc. Since, these CPT codes itself tell the patient is pregnant. When, we are coding V22.2 along with these codes, we are contradicting these CPT codes, since V22.2 says pregnancy state incidental. Now, when the patient is undergoing an OB exam (pregnancy exam), how can it be incidental. Hence, while coding OB CPT codes, be sure not to report incidental pregnancy code V22.2.

Do not code V22.2 as primary, since this code is incidental so it will always be used as secondary code. Coding it as primary will not be able to pay for the procedure since, the payer will ask for the diagnosis he came for. V22.2 states as incidental pregnancy, which will not qualify to be coded as primary diagnosis.

Do not code V22.0 and V22.1 where there is any complication present related to pregnancy. When we are coding complication codes from chapter 11 along with V22.0 or V22.1, we are considering complications as normal, which is not at all possible. When complication is present, the patient will not have normal supervision, hence we are supposed to report pregnancy supervision icd code V22.0 and V22.1 along with complication.

Final and very important, do no code any of these two V codes together, if coded together the procedure will not get paid.