Ob-Gyn Coding Alert

Reader Question:

Apply the Fetal Fracture Dx to This Patient's Chart

Question: Patient was about 6cm and began to have decelerations into the 80’s. They decided to perform an emergency C-section. Because the fetal head was wedged tightly into the pelvis, the ob-gyn had great difficulty in trying to extract the baby. Several physicians attempted to deliver it without success. The incisions, both uterine and skin, were extended into a “T’ shape. Then, they were finally able to get the baby out. When all was said and done, the fetus had a femur fracture. Fetal weight was 6lbs 14oz.

What ICD-10 code(s) would be appropriate for this scenario, aside from the fetal heart decelerations?

Arizona Subscriber

Answer: First of all, you would report the femur fracture on the baby’s record, not the mother’s. You should code as the reason for the cesarean both the decelerations (O76, Abnormality in fetal heart rate and rhythm complicating labor and delivery) and the malposition of the fetus (O32.8xx0, Maternal care for other malpresentation of fetus, not applicable or unspecified).

Then, you should add modifier 22 (Increased procedural services) to the delivery code (59514, Cesarean delivery only).