Reimbursement Q&A: ICD-10 Pregnancy
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?
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 on our website or email your inquiries to the Reimbursement Committee at pc@womenshealthapta.org.
Author: Kelly Huestis, PT, MPT, is chair of the Reimbursement Committee for the Section on Women’s Health.
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