Coding, Classification and Reimbursement

GBS unknown at time of delivery

  • 1.  GBS unknown at time of delivery

    Posted 01-10-2019 11:08
    I would like to know how you all would handle a chart where mom was not tested for GBS prior to delivery and provider states mom is GBS unknown and has started antibiotics for prophylaxis.  Do you consider that to be a suspected condition and code it as positive, or do you not code it since it's not defined as positive?

    Veronica Hawthorne, CPC

  • 2.  RE: GBS unknown at time of delivery

    Posted 01-11-2019 08:05
    Since the GBS wasn't confirmed, this falls under a prophylactic antibiotic and I would not assign a code per the index (Prophylactic>administration of>antibiotics>short-term use - omit code).

    Kristi Pollard, RHIT, CCS, CPC, CIRCC
    Senior Coding Consultant and AHIMA-Approved ICD-10-CM/PCS Trainer
    Haugen Consulting Group

  • 3.  RE: GBS unknown at time of delivery

    Posted 01-11-2019 09:55
    Good question Veronica.  I have not coded this to GBS  positive since it is unknown even though, as you pointed out, patient is given IV antibiotics.  So, is GBS unknown with treatment the same as possible GBS which can be coded as present with inpatients.  I don't know.  What are the opinions out there?  Thanks everyone.

    Nelda Laskey RHIT
    Coder/RAC Coordinator
    Kearny County Hospital

  • 4.  RE: GBS unknown at time of delivery

    Posted 01-11-2019 20:36
    I think the important word here is prophylactic. They are giving the patient prophylactic antibiotics, just in case she has possible GBS, so it doesn't transfer to the baby during the labor. Usually they test pregnant women for GBS bacteria late in pregnancy (between 35 and 37 weeks), however, as we all know, babies like to surprise everyone and sometimes there's no time for those labs and that's when we usually see documentation of "unknown GBS". They administer prophylactic antibiotics not to treat GBS, but to make sure it doesn't transfer over and infect the newborn. In this case we wouldn't code it GBS, since the administration of the antibiotics is prophylactic (as mentioned above index tells us to omit it). If they would say "possible GBS", then I think we could code it as such (on an inpatient chart), but honestly I've never seen a documentation like that. If the test is done, then we see documentation of positive/negative GBS, and when it isn't we see documentation of unknown.

    Adam Jachymiak, RHIT, CCS
    Inpatient Coder