Description:

If the claim has a CPT code related to maternity, then it must have at least one diagnosis related to maternity too. It can be either the principal or a secondary diagnosis. Otherwise, this edit raises an error for every maternity CPT code.
If the claim has an ICD-10-CM related to maternity, then it must have at least one CPT code related to maternity too. However, the hospital can report maternity for reporting purposes only. Therefore, if the claim has no CPT related to maternity, this edit raises a warning for every maternity ICD-10-CM code.

Edit ID: 10009

Error type: ERROR

Error message example 1:

This example is provided for the following scenario:

CPT code = 89290.
Principal ICD-10-CM code = C50.119.
Secondary ICD-10-CM code = E28.1.
Secondary ICD-10-CM code = Q51.11.

CPT code 89290 is related to maternity. Therefore, the claim would have at least one diagnosis related to maternity too.

DESCRIPTION

CPT code 89290 = Biopsy, Oocyte Polar Body Or Embryo Blastomere, Microtechnique (For Pre-Implantation Genetic Diagnosis); Less Than Or Equal To 5 Embryos

Principal diagnosis code C50.119 = Malignant neoplasm of central portion of unspecified female breast

Secondary diagnosis code E28.1 = Androgen excess

Secondary diagnosis code Q51.11 = Doubling of uterus with doubling of cervix and vagina with obstruction

Warning message example 2:

This example is provided for the following scenario:

Secondary ICD-10-CM code = O00.2.
CPT code = 57505.
CPT code = 81215.
CPT code = 84830.
CPT code = 00950.

Secondary diagnosis code O00.2 is related to maternity. Therefore, the claim would have at least one CPT code related to maternity too, unless the diagnosis O00.2 is submitted for reporting purposes only.

DESCRIPTION

Secondary diagnosis code O00.2 = Ovarian pregnancy

CPT code 57505 = Endocervical Curettage (Not Done As Part Of A Dilation And Curettage)

CPT code 81215 = Brca1 (Breast Cancer 1) (Eg, Hereditary Breast And Ovarian Cancer) Gene Analysis; Known Familial Variant

CPT code 84830 = Ovulation Tests, By Visual Color Comparison Methods For Human Luteinizing Hormone

CPT code 00950 = Anesthesia For Vaginal Procedures (Including Biopsy Of Labia, Vagina, Cervix Or Endometrium); Culdoscopy

Error message example 3:

This example is provided for the following scenario:

CPT code = 81512.
Principal ICD-10-CM code = A18.18.
Secondary ICD-10-CM code = C50.111, D07.30, E28.310, G43.821 and N77.1.
The error message shows the description of a maximum of 5 ICD-10-CM codes to save the size of the message.
The last sentence contains a note regarding the 6th ICD-10-CM code.

CPT code 81512 is related to maternity. Therefore, the claim would have at least one diagnosis related to maternity too.

DESCRIPTION

CPT code 81512 = Fetal Congenital Abnormalities, Biochemical Assays Of Five Analytes (Afp, Ue3, Total Hcg, Hyperglycosylated Hcg, Dia) Utilizing Maternal Serum, Algorithm Reported As A Risk Score

Principal diagnosis code A18.18 = Tuberculosis of other female genital organs

Secondary diagnosis code C50.111 = Malignant neoplasm of central portion of right female breast

Secondary diagnosis code D07.30 = Carcinoma in situ of unspecified female genital organs

Secondary diagnosis code E28.310 = Symptomatic premature menopause

Secondary diagnosis code G43.821 = Menstrual migraine, not intractable, with status migrainosus

Note: refer to the coding documentation for a description of secondary diagnosis code N77.1.

Owner object: Diagnosis / Activity

Owner object property name: Code

Owner object property value: Value of Diagnosis.Code / Activity.Code

Reference object: Claim

Reference object property name: ID

Reference object property value: Value of Claim.ID