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Reimbursement Q & A: ICD-10 and Pregnancy

Posted on: August 30th, 2016 by Kristin Clarke No Comments

By Kelly Huestis, PT, MPT

Confused about physical therapy reimbursement coding related to your pregnant patients? Here’s one example:

Question: I work with several pregnant patients for sciatica, low back pain, and pelvic pain. Do I need to code for the patient being pregnant and then code for the pain and functional problems or just the pain and functional problems?

Unsure how to code for reimbursement related to pregnant patients? Kelly Huestis has your back.

Unsure how to code for reimbursement related to pregnant patients? Kelly Huestis has your back.

Answer: As a physical therapist, you should always code for the primary diagnoses that you are treating first. This includes codes such as weakness, pain, balance, and functional limitations. Pregnancy should be considered like a medical diagnosis or secondary diagnosis.

As the therapist, you are not actually treating the pregnancy per se but rather the musculoskeletal symptoms associated with it.  Unless you have a confirmed, detailed ICD-10 code from the physician, you would not bill an ICD-10 code for the pregnancy.

These codes can be complex and can be broken down as far as weeks and complications. Document the pregnancy in your notes to assist with reimbursement and submit ICD-10 codes for the impairments you are actually addressing.

Some common ICD-10 codes used during pregnancy include the following:

M54.4_                 Lumbago with sciatica (be sure to specify side to assure payment)

M53.3                   Sacral disorders, not elsewhere classified (coccygodynia, pain in sacrum)

M25.50                 Pain in unspecified joint

M25.55_              Pain in hip (specify side)

M62.838               Muscle spasm, other

M62.81                 Muscle weakness

R29.3                     Posture abnormality

R26.2                     Difficulty in walking, not elsewhere classified

R26.89                   Other abnormalities of gait and mobility

For more resources on ICD-10 coding for the women’s health patient, check out the SOWH ICD-10 page located under the “Practice” tab at www.womenshealthapta.org or email your inquiries to the Reimbursement Committee at [email protected].

Author: Kelly Huestis, PT, MPT, is chair of the Reimbursement Committee for the Section on Women’s Health.

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