Ob-Gyn Coding Alert

Question: I had a question regarding the ICD-9 code 651.3X and ultrasound (US) coding. For example, the patient has a multiple pregnancy, and one of the fetuses shows no cardiac activity on US. What would be the primary code, and would 632 fit in anywhere here? The reason I ask this is because while it is a loss, the fetus in not expelled and may remain in utero until delivery of the live fetus/es.

California Subscriber

Answer: The ICD-9 coding staff weighed in on this one and said that fetal loss is fetal loss even if retained. So you should use 651.3 (Twin pregnancy with fetal loss and retention of one fetus [0,1,3]). But they did admit, however, that it was not a perfect solution, but that it would probably not be appropriate to code both 632 (Missed abortion) and 651.xx.

Also, keep in mind that in this case, per the American Congress of Obstetricians and Gynecologists (ACOG) and Society for Maternal-Fetal Medicine (SMFM), a twin pregnancy is still a twin pregnancy even when one dies and is retained. 

ICD-10: This coding issue will be addressed in ICD-10 where you will have a code for "Continuing pregnancy after intrauterine death of one fetus or more." Specifically, these codes are:

• O31.20 -- Continuing pregnancy after intrauterine death of one fetus or more, unspecified trimester
• O31.21 -- ... first trimester
• O31.22 -- ... second trimester
• O31.23 -- ... third trimester

You will also have codes for continuing pregnancy after one or more abortions, and a code when one or more is reduced. They are O31.1 (Continuing pregnancy after spontaneous abortion of one fetus or more) and O31.3 (Continuing pregnancy after elective fetal reduction of one fetus or more).