Ob-Gyn Coding Alert

Tip: Despite unspecified codes, submit dx with the highest level of specificity.

A twin pregnancy is one where the mother carries two fetuses. This may include one placenta and one amniotic sac, one placenta and two amniotic sacs, or two placentae and two amniotic sacs.

To correctly report twin pregnancies in ICD-10, your provider has to document the following:

• twin pregnancy
• specific trimester
• number of placentae
• number of amniotic sacs

ICD-9-CM Codes: Here is how you currently report twin pregnancies:

651.00, Twin pregnancy, unspecified as to episode of care

651.01, Twin pregnancy delivered; or

651.03, Twin pregnancy antepartum condition or complication;

• with V91.00, Twin gestation, unspecified number of placenta, unspecified number of amniotic sacs; or
• with V91.01, Twin gestation, monochrionic/monamniotic (one placenta, one amniotic sac); or
• with V91.02, Twin gestation, monochrionic/diamoniotic (one placenta, two amniotic sacs); or
• with V91.03, Twin gestation, dichorionic/diamniotic (two placentae, two amniotic sacs); or
• with V91.09, Twin gestation, unable to determine number placenta and number of amniotic sacs

ICD-10-CM Codes: Here is how your diagnosis coding options will expand:

O30.001, Twin pregnancy, unspecified number of placenta and unspecified number of amniotic sacs, first trimester

O30.002, Twin pregnancy, unspecified number of placenta and unspecified number of amniotic sacs, second trimester

O30.003, Twin pregnancy, unspecified number of placenta and unspecified number of amniotic sacs, third trimester

O30.009, Twin pregnancy, unspecified number of placenta and unspecified number of amniotic sacs, unspecified trimester

O30.011, Twin pregnancy, monoamniotic/monochorionic, first trimester

O30.012, Twin pregnancy, monoamniotic/monochorionic, second trimester

O30.013, Twin pregnancy, monoamniotic/monochorionic, third trimester

O30.019, Twin pregnancy, monoamniotic/monochorionic, unspecified trimester

O30.031, Twin pregnancy, monochorionic/diamniotic, first trimester

O30.032, Twin pregnancy, monochorionic/diamniotic, second trimester

O30.033, Twin pregnancy, monochorionic/diamniotic, third trimester

O30.039, Twin pregnancy, monochorionic/diamniotic, unspecified trimester

O30.041, Twin pregnancy, dichorionic/diamniotic, first trimester

O30.042, Twin pregnancy, dichorionic/diamniotic, second trimester

O30.043, Twin pregnancy, dichorionic/diamniotic, third trimester

O30.049, Twin pregnancy, dichorionic/diamniotic, unspecified trimester

O30.091, Twin pregnancy, unable to determine number of placenta and number of amniotic sacs, first trimester

O30.092, Twin pregnancy, unable to determine number of placenta and number of amniotic sacs, second trimester

O30.093, Twin pregnancy, unable to determine number of placenta and number of amniotic sacs, third trimester

O30.099, Twin pregnancy, unable to determine number of placenta and number of amniotic sacs, unspecified trimester

ICD-10-CM Change: Currently, you would report 651.01 or 651.03 for twins with a V91.0x specifying the number of amniotic sacs and placentae. In 2013, ICD-10-CM will combine these codes into single options for twin pregnancy based on specific trimester as well as the number of placenta and amniotic sacs.

You do have unspecified trimester and unspecified number of placentae/amniotic sacs coding options, but you should always code to the highest specificity. You also have an option to report when the physician cannot determine the placenta/amniotic sac status of the pregnancy, but the physician must document this fact in the record.

Here is how you will find these codes in your Alphabetic Index:

Pregnancy (childbirth) (labor) (puerperium) --see also Delivery and Puerperal

- twin O30.00 -- see Tabular for required trimester

- - dichorionic/diamniotic (two placenta, two amniotic sacs) O30.04-

- - monochorionic/diamniotic (one placenta, two amniotic sacs) O30.03-

- - monochorionic/monoamniotic (one placenta, one amniotic sac) O30.01-

- - unable to determine number of placenta and number of amniotic sacs O30.09-

- - unspecified number of placenta and unspecified number of amniotic sacs O30.00-

Coder tips: Underneath the O30 category, you'll see a note saying you should code any complications specific to multiple gestation.

Underneath the O30.01 category, you will find an Excludes1 note that forbids you from reporting these codes with conjoined twins (O30.02-).