Ob-Gyn Coding Alert

Prepare to implement these changes, sans grace period, Oct. 1 Along with the new V codes coming down the pipeline, you've got two new areas of regular ICD-9 codes to contend with as of Oct. 1: The new codes for multiple gestation following fetal reduction and peritonitis expand pre-existing codes, so it's key to begin differentiating these codes earlier rather than later. Get the Gist of New 'Elective' Gestation Codes If your ob-gyn has seen a patient who has undergone fetal reduction for large-number multiple-gestation pregnancies, then you know that ICD-9 does not include a code to reflect this condition - until now.
 
After Oct. 1, you'll have the opportunity to use the following codes:
  651.70 - Multiple gestation following (elective) fetal reduction, unspecified as to episode of care or not applicable
  651.71 - Multiple gestation following (elective) fetal reduction, delivered, with or without mention of antepartum condition
  651.73 - Multiple gestation following (elective) fetal reduction, antepartum condition or complication. Notice the difference in the definitions; what code you'll use depends on (1) unspecified episode of care, (2) the delivery with or without an antepartum condition, or (3) with an antepartum condition or complication.

In some cases, the mother or the multiple babies (such as triplets) are endangered if she carries all of the babies until delivery. Therefore, the ob-gyn may recommend that one of the fetuses be terminated, says Nadia Noor, CPC, a reimbursement specialist at the Austin Diagnostic Clinic in Texas.

Heads-up: Fetal reduction procedures reduce the risk to the remaining fetuses, but you should still consider the pregnancy high-risk, especially following a fetal reduction procedure, says a coding instructor in Santa Rosa, Calif.

Red flag: Don't confuse these codes for multiple gestation following elective fetal reduction with the existing multiple-gestation codes 651.3x-651.6x.

For now: An ob-gyn sees a patient with a triplet pregnancy and discovers that two of the babies appear normal, but the third has anencephaly, a defect in brain development resulting in small or missing brain hemispheres. The patient decides to have a fetal reduction. The ob-gyn performs this procedure in her second trimester to optimize the survival of the two normal-appearing fetuses. You would report 651.43 (Triplet pregnancy with fetal loss and retention of one or more fetus[es]; antepartum condition or complication).

In the future: After Oct. 1, you should look to 651.40-651.73 for the appropriate code.

If the ob-gyn admits the patient for the termination, you should use the elective abortion code with a category 651 code (Multiple gestation) for the pregnancy count at the time of the reduction. If the ob-gyn admits the patient for a status situation after the fact, you should use 651.7x without the termination code. Keep in mind that you can use 651.7x with any other complication [...]