Resolved Z38.31 and DRG

[StacieH_45586]

Question: Can Z38.31 be retained without a procedure code for an infant patient? I understand this code is not reported on the maternal record. But should the UB-04 have it's respective procedure code?

 

[Darcy]

Question: Can Z38.31 be retained without a procedure code for an infant patient? I understand this code is not reported on the maternal record. But should the UB-04 have it's respective procedure code?

• Z38.31 is a diagnosis code that indicates "twin gestation, monochorionic/monoamniotic (one placenta, one amniotic sac)". It is used to report conditions in twin pregnancies.
• Diagnosis codes like Z38.31 are not tied to specific procedure codes. The procedure codes reported should accurately describe the medical services provided to the patient.
• For newborn infant patients, it is common to report diagnosis codes that describe their condition at birth, even if no procedures were performed. This provides important clinical detail.
• However, on hospital claims, payers generally require a procedure code to justify an inpatient stay. Codes like Z38.31 would need a procedure code on the UB-04 to support the infant's admission. Commonly reported procedures include things like
  • routine newborn care, circumcision, etc.
  • The infant's Z38.31 code would not be reported on the mother's claim. Her diagnoses and procedures would be reported separately.
• So in summary, Z38.31 could potentially be reported alone on the newborn's chart to capture the clinical detail. But the UB-04 claim would need an appropriate procedure code to support the infant's admission and meet billing requirements

 

[StacieH_45586]

• Z38.31 is a diagnosis code that indicates "twin gestation, monochorionic/monoamniotic (one placenta, one amniotic sac)". It is used to report conditions in twin pregnancies.
• Diagnosis codes like Z38.31 are not tied to specific procedure codes. The procedure codes reported should accurately describe the medical services provided to the patient.
• For newborn infant patients, it is common to report diagnosis codes that describe their condition at birth, even if no procedures were performed. This provides important clinical detail.
• However, on hospital claims, payers generally require a procedure code to justify an inpatient stay. Codes like Z38.31 would need a procedure code on the UB-04 to support the infant's admission. Commonly reported procedures include things like
  • routine newborn care, circumcision, etc.
  • The infant's Z38.31 code would not be reported on the mother's claim. Her diagnoses and procedures would be reported separately.
• So in summary, Z38.31 could potentially be reported alone on the newborn's chart to capture the clinical detail. But the UB-04 claim would need an appropriate procedure code to support the infant's admission and meet billing requirements

Darcy, I appreciate your help. I'm new to the DRG world, and FOR SURE new to OB. My UB-04 does not have a procedure code, and they have billed Z38.31. One infant was with hypoglycemia in the fist couple of hours. They fed the premature infant with tube feeding supplementation. My thoughts were Z38.31 wasn't appropriate without a billed procedure and a more appropriate code would be P07.39. However, as I got to thinking, I thought, "Well how can you have preterm newborn w/ out it's respective Z38.31, even though there is no procedure.

 

[Darcy]

Darcy, I appreciate your help. I'm new to the DRG world, and FOR SURE new to OB. My UB-04 does not have a procedure code, and they have billed Z38.31. One infant was with hypoglycemia in the fist couple of hours. They fed the premature infant with tube feeding supplementation. My thoughts were Z38.31 wasn't appropriate without a billed procedure and a more appropriate code would be P07.39. However, as I got to thinking, I thought, "Well how can you have preterm newborn w/ out it's respective Z38.31, even though there is no procedure.

You can only code from physician documentation. You can not make assumptions or leaps. Also, what are you trying to bill for? If only admission then this code is fine.