Ob-Gyn Coding Alert

Question: Please help me figure out the correct application of the 7th character in this case. I know typically the 7th character is applied to the affected fetus.

The note states “Twin Pregnancy, with spontaneous abortion of Fetus 2.” In this case would we use O31.11X1 because fetus 1 is continuing pregnancy? Or O31.11X2 because Fetus 2 was the one that was the demise?

California Subscriber

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 digit of 1 (linked to that evaluation) and 2 (linked to that E/M service). The codes you would use are 76815 (Ultrasound, pregnant uterus, real time with image documentation, limited [e.g., 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.