Page 90 - Claims Handbook

Potential Processing Steps:

Examiners shall look in the member’s benefit profile and confirm if they have reached their test limits. If the
benefit limit has been reached, the processor shall deny the claim “P9.” If the benefit limit has not been

reached, override and process the claim.

Be sure to confirm the pregnancy diagnosis is on the claim and to verify the number of tests allowed.

ICD-9 to ICD-10 Diagnosis Conversion Table

ICD-9 ICD-10
Diagnosis
Diagnosis Description Description
Code Code
Z34.00 Encounter for supervision of normal first
V22.0 Supervision of normal first pregnancy pregnancy, unspecified trimester
Z34.01 Encounter for supervision of normal first
V22.1 Supervision of other normal Z34.02 pregnancy, first trimester
pregnancy Encounter for supervision of normal first
Z34.03 pregnancy, second trimester
V23.9 Supervision of unspecified high-risk Encounter for supervision of normal first
pregnancy Z34.80 pregnancy, third trimester
Encounter for supervision of other
V69.8 Other problems related to lifestyle Z34.81 normal pregnancy, unspecified trimester
Encounter for supervision of other
V73.89 Screening, disease or disorder, viral, Z34.82 normal pregnancy, first trimester
V74.5 specified type NEC Z34.83 Encounter for supervision of other
Screening, bacterial - sexually normal pregnancy, second trimester
transmitted Z34.90 Encounter for supervision of other
normal pregnancy, third trimester
Z34.91 Encounter for supervision of normal
pregnancy, unspecified, unspecified
Z34.92 trimester
Encounter for supervision of normal
Z34.93 pregnancy, unspecified, first trimester
Encounter for supervision of normal
O09.90 pregnancy, unspecified, second
trimester
O09.91 Encounter for supervision of normal
pregnancy, unspecified, third trimester
O09.92 Supervision of high risk pregnancy,
unspecified, unspecified trimester
O09.93 Supervision of high risk pregnancy,
Z72.89 unspecified, first trimester
Z72.51 Supervision of high risk pregnancy,
Z72.52 unspecified, second trimester
Z72.53 Supervision of high risk pregnancy,
Z11.59 unspecified, third trimester
Other problems related to lifestyle
Z11.3 High risk heterosexual behavior
High risk homosexual behavior
High risk bisexual behavior
Encounter for screening for other viral
diseases
Encounter for screening for infections
with a predominantly sexual mode of
transmission

* For ICD-10 diagnosis codes, see the ICD-9 to ICD-10 Diagnosis Conversion Table on page 4.
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