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Diabetes with Pregnancy Patient Encounter

A 33-year old G2P1 female presented for her routine prenatal visit at 30 weeks gestation to see her obstetrician. With this pregnancy, her first prenatal visit was at 20 weeks and she has sporadically kept her appointments up to this visit. To note, her previous pregnancy two years ago was an uncomplicated vaginal delivery at 38 weeks gestation. The baby weighed 4.2kg at delivery and was complicated by shoulder dystocia. She had minimal general medical care between the pregnancies. At the patient’s 28 week visit, her prenatal surveillance included an abnormal 1-hr glucose challenge test. She returned for a follow up 3-hr OGTT, which revealed abnormal findings; these results were shared with the patient at the 30 week visit. Upon questioning, the patient admitted that there is a family history of diabetes in several of her relatives; however, she has never been tested for diabetes. The patient’s evaluation also demonstrated a body mass index (BMI) of 34, BP 130/78 and fetal heart tones at 148 BPM. Based on these results, the obstetrician diagnosed the patient with gestational diabetes mellitus (GDM) and established a plan of care for the duration of her pregnancy. This plan of care included nutritional counseling with monitoring of her blood glucose as well as possible medical intervention, if glycemic control could not be established. Additionally, the plan called for increased antenatal surveillance based on glycemic control

Coding: ICD-9 to ICD-10

In ICD-9-CM, gestational diabetes mellitus codes to 648.83, Abnormal glucose tolerance of mother, antepartum condition or complication. In ICD-10, this condition maps to code O24.410, Gestational diabetes mellitus in pregnancy, diet controlled. Note the change in terminology between ICD-9 and ICD-10 describing the specification of Gestational diabetes mellitus. Additional ICD-10 parameters for gestational diabetes also include the control mechanism as either insulin or diet. Should the status of the patient’s gestational diabetes change during the course of her pregnancy or in the post-partum period, it can be reflected by the choice of code, as referenced in the “Comparison of Current ICD-9 Code and Illustrative ICD-10 Codes” table below. It is also important to note that if the patient had been diagnosed with diabetes prior to her pregnancy, there are codes now available in ICD-10 to indicate the pre-existing condition and the current trimester. Similar to the general classification for diabetes mellitus, the codes include classifications type 1 and type 2 diabetes and similar to gestational diabetes mellitus, the codes include the classifications for “in childbirth” and “in the puerperium”.

eHealth Connection

The ability of ICD-10-CM to capture more data in terms of depth and specificity helps providers to recognize differences in the risk, severity, and complexity of each case. This is of particular importance as our healthcare system moves towards value based healthcare. Better identification and documentation of the complexity of a patient’s condition enables greater data collection of the specific care rendered to a patient. From this data comes the ability to demonstrate the true value of the care physicians provide to their patient populations.

Comparison of Current ICD-9 Code and Illustrative ICD-10 Codes

ICD-9-CM


648.83 Abnormal glucose tolerance, antepartum condition or complication

ICD-10-CM

Correct Code:

O24.410 Gestational diabetes mellitus in pregnancy, diet controlled

Other Illustrative ICD-10 Codes That Map to the Current ICD-9 Code:

O24.414 Gestational diabetes mellitus in pregnancy, insulin controlled

O24.420 Gestational diabetes mellitus in childbirth, diet controlled

O24.424 Gestational diabetes mellitus in childbirth, insulin controlled

O24.434 Gestational diabetes mellitus in the puerperium, insulin controlled

O24.011 Pre-existing diabetes mellitus, type 1, in pregnancy, first trimester

O24.012 Pre-existing diabetes mellitus, type 1, in pregnancy, second trimester

O24.013 Pre-existing diabetes mellitus, type 1, in pregnancy, third trimester

O24.02 Pre-existing diabetes mellitus, type 1, in childbirth

O24.03 Pre-existing diabetes mellitus, type 1, in the puerperium

O24.111 Pre-existing diabetes mellitus, type 2, in pregnancy, first trimester

O24.112 Pre-existing diabetes mellitus, type 2, in pregnancy, second trimester

O24.113 Pre-existing diabetes mellitus, type 2, in pregnancy, third trimester

O24.12 Pre-existing diabetes mellitus, type 2, in childbirth

O24.13 Pre-existing diabetes mellitus, type 2, in the puerperium