Ob-Gyn Coding Alert


How to Apply ICD-10-CM Codes to Fetus 1, Fetus 2

Is your ob-gyn not consistent identifying the fetus? Here’s what to do.

In multiple gestation scenarios, identifying the fetus with a 7th character for your ICD-10 codes can be tricky. Check out these frequently asked questions and answers, so that you can find solutions.

Discover What Seventh Character You Should Choose

Question 1: A patient is pregnant with twins and is experiencing a complication in her second trimester. What seventh character should I use?

Answer: Code O31.8x2- is a code for other complications specific to multiple gestations in the second trimester, which we can use as an example. You’re right that you need to pay attention to the final character of the multiple gestation code.

So O35.8x21 (Other complications specific to multiple gestations, second trimester, fetus 1) would mean this complication occurred on fetus one, while O35.8x21 (…fetus 2) would mean fetus two had the issue. If you used O35.8x23 (… fetus 3), O35.8x24 (…fetus 4), O35.8x25 (…fetus 5), this would mean that a fetus other than third, fourth, or fifth fetus had the complication, but you stated the patient has twins, so you should use either a seventh character of “1” or “2” for either fetus one or fetus two.

You should not choose O31.8x29 (…other fetus) or O31.8x20 (…not applicable or unspecified), because you should always choose the code of highest specificity.

Focus on the Encounter to Identify Fetus Number

Question 2: Suppose your ob-gyn treats a patient with a twin pregnancy, with a spontaneous abortion of fetus 2. In this case, would you use O31.11x1 because fetus 1 is continuing the pregnancy? Or should we use fetus 2 because that was the demise?

Answer: Normally you will use the code that is directed at the fetus whose issue is currently being addressed.

If this visit is all about handling fetus 2, then the 7th character is 2. The code would be O31.11x2 (Continuing pregnancy after spontaneous abortion of one fetus or more, first trimester, fetus 2).

If that is now past and the fetus 1 is continuing, then the final character is 1 (O31.11x1, ... fetus 1).

If the ob-gyn is evaluating both fetuses (the physician might do an ultrasound to see the status of fetus 1), then use the code twice with a 7th character of 1 (linked to that evaluation) and 2 (linked to that E/M service). The codes you would use might be 76815 (Ultrasound, pregnant uterus, real time with image documentation, limited [eg, fetal heart beat, placental location, fetal position and/or qualitative amniotic fluid volume], 1 or more fetuses) to check on fetus 1 and 99222 (Initial hospital care, per day, for the evaluation and management of a patient ...) for the medical management of the spontaneous abortion in the hospital.

Here’s How to Handle Fetus A, B Documentation

Question 3: Suppose your ob-gyn documents a patient›s twins as “fetus A” and “fetus B”. However, you know that the fetal extensions in chapter 15, Pregnancy, childbirth and the puerperium, for codes related to complications of multiple gestation (e.g., O31, O32, etc.) refer to fetus 1, fetus 2, and so on and so forth. What should you do?

Answer: According to the AHA ICD-10-CM Coding Clinic (2012 Vol. 29 No. 04), you should assume fetus A means fetus 1, and fetus B means fetus 2.

Remember, your ob-gyn may not consistently document the same fetus number or alphabetical character from one admission to the other. You have to go with whatever the provider documents.

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