Q&A: Coding diabetes and pregnancy

Q: How do you code an encounter with a pregnant patient with diabetes?

A: The prevalence of diabetes in pregnancy has been increasing in our country. Not only is the prevalence of Type 1 or Type 2 diabetes increasing in individuals of reproductive age, but there's also dramatic increase in the rates of gestational diabetes. Diabetes confers significantly greater maternal and fetal risk that is largely related to the degree of hypoglycemia but also related to chronic complications and comorbidities of diabetes.

There are two types of diabetes medical coders are going to encounter when coding for a pregnant diabetic patient: preexisting diabetes and gestational diabetes.

Preexisting is diabetes that a pregnant woman had before getting pregnant. Gestational diabetes is a special type of diabetes that can develop some time in the second or third trimester of pregnancy. Anyone who is pregnant can develop gestational diabetes, but women are more likely to develop this type of diabetes if they are overweight, have obesity, have a family history of diabetes, had gestational diabetes in a previous pregnancy, or have given birth to a baby weighing nine pounds or more. Having gestational diabetes also places a woman at greater risk of developing diabetes after pregnancy as well.

Now let’s talk about coding for diabetes in pregnancy. A patient who has preexisting diabetes who becomes pregnant should be assigned a code from ICD-10-CM category O24.- first, followed by the diabetes code(s) from Chapter 4.

The fourth character of the code identifies the type of diabetes as: preexisting Type 1, pre-existing Type 2, pre-existing unspecified, or gestational. The fifth character indicates whether the diabetes is treated during pregnancy, childbirth, or puerperium. And the sixth character indicates the trimester during which treatment is sought.

Codes for gestational diabetes are in subcategory O24.4-. These codes include treatment modality—diet alone, oral hypoglycemic drugs, insulin—so no additional code is needed to specify medication management because it's already within the description of the code.

Editor’s note: This article originally appeared in JustCoding. This information was provided by Yelena Smirnykh, CPC-I, CPC, CDEO, CCDS-O, CMRS, CPB, during HCPro’s webinar, “Diabetes Coding Made Clear: Capturing the Complications.”