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Last month, we discussed OB/GYN coding as part of our ICD-10 Quick Tips blog series.  This week, we will continue our discussion of OB/GYN coding and focus on coding of multiple gestations.  In our past life (ICD-9!) we did not have too many options to capture this data, but ICD-10 certainly took care of that for us!  We now have new coding concepts to address and apply, so let’s take a look at one of the biggest changes involving multiple gestation coding.  Once again, I want to start with some basic information which is critical for understanding this concept of coding.

The first thing we must understand is the th ree different types of multiple gestations:

  • Monoamniotic/monochromic (mo/mo): Mo/mo twins share the same amniotic sac and share the same placenta within the uterus.  These multiples are always identical, but have two separate umbilical cords.
  • Monoamniotic/diamniotic (mono/di): Mono/di twins generally have two amniotic sacs (a fetus in each sac) yet share the same placenta and have separate umbilical cords.  These multiples are also identical.
  • Dichorionic/diamniotic (di/di): This is the most common form of multiples.  These type of twins usually have two amniotic sacs and two placentas.  Di/di twins are commonly referred to as fraternal twins.  This type of multiple rarely produces identicals.

To identify the fetus in a multiple gestation that is affected by the condition being coded.  These are the applicable seventh characters:

  • The seventh character 0 is for single gestations and multiple gestations where the affected fetus is unspecified.
  • Seventh characters 1 through 9 are for cases of multiple gestations to identify the fetus for which the code applies.
    • 0 – not applicable or unspecified (also used for single pregnancies)
    • 1 – Fetus 1
    • 2 – Fetus 2
    • 3 – Fetus 3
    • 4 – Fetus 4
    • 5 – Fetus 5
    • 9 – Other Fetus
  • A code from category O30, Multiple gestation must also be assigned when assigning these codes

Therefore, if the physician is caring for a pregnant woman with the baby in breech presentation, you would report the appropriate seventh character from 1 through 9 to specify fetus 1, fetus 2, etc.

  • For example – Mary, pregnant with twins, is close to her due date and the physician noticed that fetus 2 is in breech position.  Report code 032.1xx2 (maternal care for breech presentation, fetus 2).
  • Another example – Joan, pregnant with her first baby (single gestation), is ready to deliver but the baby is in breech position.  Report 032.1xx0 (maternal care for breech presentation, not applicable).

Physicians often document twins as fetus A and fetus B.  However, 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. For the purposes of selecting the seventh character for these codes, it is appropriate to assume that fetus A is fetus 1 and B is 2, etc.

There you have it folks!  Hope you found this short and sweet summary of coding multiple gestations in ICD-10!

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