Ob-Gyn Coding Alert

Question: A patient had fetal demise and delivered the fetus on the way to the hospital, but we had to perform a D&C because she continued bleeding. For the ICD-9 code, should I use a fifth digit of "1" or "2"?

Kentucky Subscriber

Answer: What digit you use depends on whether some products of conception remain.

The ICD-9 guidelines for using abortion codes- fifth digit state the following:

- A "1" (Incomplete) indicates that all of the products of conception have not been expelled from the uterus.

- "2" (Complete) indicates that all products of conception have been expelled from the uterus.-

Examples: You can have a spontaneous miscarriage of the fetus but with retained products of conception that your ob-gyn must remove surgically.-In that case, your fifth digit should be "1."

If the patient had delivered the fetus and at the hospital the ob-gyn determined she expelled all of the products, you instead would use a fifth digit of "2".

Keep in mind: ICD-9 rules also state that should this patient, who was thought to have expelled all of the products at this visit, have to return due to continued bleeding and the physician finds she has some placental fragments still in the uterus, your fifth digit for that encounter would again be an "incomplete" ("1") abortion.