Ob-Gyn Coding Alert

Don't overlook the Includes, Excludes1, and Excludes2 notes.

Pregnant patients may present to your ob-gyn practice complaining of decreased fetal movement, which may prompt the physician to order a fetal non-stress test (NST). To support this service, you should report a decreased fetal movement diagnosis code.

ICD-9-CM Codes: Currently, you would choose one of the following codes:

• 655.70, Decreased fetal movements, affecting management of mother, unspecified as to episode of care
• 655.71, Decreased fetal movements, affecting management of mother, delivered, with or without mention of antepartum condition
• 655.73, Decreased fetal movements, affecting management of mother, antepartum condition or complication.

ICD-10-CM Codes: When your diagnosis code system changes, you will choose one of the following options instead:

• O36.8120, Decreased fetal movements, second trimester, not applicable or unspecified
• O36.8121, ... fetus 1
• O36.8122, ... fetus 2
• O36.8123, ... fetus 3
• O36.8124, ... fetus 4
• O36.8125, ... fetus 5
• O36.8129, ... other fetus
• O36.8130, Decreased fetal movements, third trimester, not applicable or unspecified
• O36.8131, ... fetus 1
• O36.8132, ... fetus 2
• O36.8133, ... fetus 3
• O36.8134, ... fetus 4
• O36.8135, ... fetus 5
• O36.8139, ... other fetus
• O36.8190, Decreased fetal movements, unspecified trimester, not applicable or unspecified
• O36.8191, ... fetus 1
• O36.8192, ... fetus 2
• O36.8193, ... fetus 3
• O36.8194, ... fetus 4
• O36.8195, ... fetus 5
• O36.8199, ... other fetus.

Change: Instead of focusing on how the decreased fetal movements affect the mother, you will soon specify the trimester and which fetus is exhibiting the decreased movement.

Documentation: Your physician will most likely document the patient's trimester, but determining which fetus is "1" and which fetus is "2" (and so on) is a bit trickier. Physicians treating multiple gestation pregnancies should come up with a system for this, such as the larger fetus is always "1" and so on.

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

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

Note: the tabular must be reviewed for assignment of the final character for trimester, the tabular must be reviewed for assignment of the correct extension for multiple gestations for all chapter 15 codes

- complicated by (care of) (management affected by)

-- decreased fetal movement O36.81-

-- fetal (maternal care for)

--- decreased movement O36.81-

Tips: If you run your above ICD-9 codes through an ICD-10 bridge, you'll see 655.71 specifically converts to the O36.8120 and O36.8130 codes; 655.70 specifically converts to the O36.8190 code; and 655.73 specifically converts to all three codes (O36.8120, O36.8130, and O36.8190). However, the 4th digit of 0 signifies a singleton pregnancy. You still have other seventh digits to specify which fetus is demonstrating the decreased fetal movement. You should always code to the highest level of specificity.

This category of codes:

Includes: the listed conditions in the fetus as a reason for hospitalization or other obstetric care of the mother, or for termination of pregnancy

Excludes1: encounter for suspected maternal and fetal conditions ruled out (Z03.7-), placental transfusion syndromes (O43.0-)

Excludes2: labor and delivery complicated by fetal stress (O77.-)

Watch out: These are "O" codes, not "0" codes.