January 19, 2009

Coding for Group B Streptococcus in Pregnancy
For The Record
Vol. 21 No. 2 P. 28

Group B streptococcus (GBS) is a type of bacteria that is normally located in the digestive, urinary, and reproductive tracts in both men and women. It’s also commonly found in pregnant women. In most cases, it does not cause any problems if properly treated during labor and delivery. A positive GBS culture result means that the mother carries the GBS bacteria, not that she or her baby will definitely become ill. A patient who has the bacteria but does not exhibit any symptoms is said to be colonized. An infection has occurred if the bacteria cause symptoms.

A pregnant woman may pass GBS to her baby during a vaginal delivery. However, medical research indicates that giving IV antibiotics to the mother during labor and delivery can greatly reduce the frequency of GBS infection in the baby immediately after birth or during the first week of life. In pregnant women, GBS may cause a urinary tract infection, sepsis, chorioamnionitis, postpartum endometritis, pelvic thrombophlebitis, and endocarditis. GBS identified in the urine should be treated with antibiotics at the time it is diagnosed.

The ICD-9-CM code assignment of a GBS infection will depend on the type of infection diagnosed. If the patient has a positive GBS culture but does not have an infection, assign codes 648.9x, Other current conditions classifiable elsewhere, plus V02.51, Carrier or suspected carrier of group B streptococcus. The fifth-digit subclassification depends on the episode of care for this admission. Code 650 cannot be assigned with any other pregnancy complication code. A GBS carrier is considered a complication of pregnancy (AHA Coding Clinic for ICD-9-CM, 2002, first quarter, pages 14-15 and 1998, fourth quarter, page 61).

When the patient has a positive GBS culture, then codes 648.9x and V02.51 may be assigned. The physician does not need to document the word “carrier” to assign code V02.51. If the physician documents that the patient has an infection, then the code for the infection is assigned instead of codes 648.9x and V02.51.

Although a positive GBS culture is considered a pregnancy complication, it is not considered a high-risk pregnancy complication. Therefore, it is not necessary to assign code V23.89, Other high-risk pregnancy, as a secondary diagnosis with codes 648.9x and V02.51, since these codes identify the condition that is making the pregnancy a high-risk case (AHA Coding Clinic for ICD-9-CM, 2006, third quarter, page 14).

GBS in Newborns
Patients with GBS culture who do not receive IV antibiotics during labor and delivery may pass GBS to the baby. If the bacteria are passed to the baby, the baby may develop GBS infection. However, not all babies who are exposed to GBS will develop an infection.

According to the Coding Clinic, assign the appropriate code from category V30, Liveborn infant, as the principal diagnosis and code V02.51 as a secondary diagnosis for a newborn that has GBS. “Even though the infant was given antibiotics, he or she would still be considered a carrier or suspected carrier since there was no evidence of an infection” (AHA Coding Clinic for ICD-9-CM, 1994, third quarter, page 4).

Newborns who develop an infection may be classified as an early or late infection. An early infection may develop shortly after delivery and up to seven days after birth. A late infection occurs seven days or more after birth. If an infection develops because of GBS, assign the appropriate ICD-9-CM code based on the type of infection.

Coding and sequencing for GBS in pregnancy are dependent on the physician documentation in the medical record and application of the Official Coding Guidelines for inpatient care. Also, use specific AHA Coding Clinic for ICD-9-CM and American Medical Association CPT Assistant references to ensure complete and accurate coding.

— This information was prepared by Audrey Howard, RHIA, of 3M Consulting Services. 3M Consulting Services is a business of 3M Health Information Systems, a supplier of coding and classification systems to nearly 5,000 healthcare providers. The company and its representatives do not assume any responsibility for reimbursement decisions or claims denials made by providers or payers as the result of the misuse of this coding information. More information about 3M Health Information Systems is available at www.3mhis.com or by calling 800-367-2447.