Ob-Gyn Coding Alert

Question: My ob-gyn delivered triplets vaginally. This mother did not have global care with us. She will return for postpartum. Should I code this triplet delivery with 59410, 59409-51, 59409-51 with DX 060.12x0, 009.812, 031.32x0, 030.102, Z3a.20, Z37.61? My ob-gyn documented:

“_____________ is a 35 y.o. G3P0020 who presented at 20w1d IVF pregnancy, s/p multigestation reduction from triplet to singleton pregnancy at 16wks admitted on 4/7/2020 for preterm labor. Upon admission, her SVE was 0.5/0.5/-3 and she was contracting painfully. She received morphine 15mg IM and phenergan 25mg IM for pain control. She ruptured and subsequently precipitously delivered fetus, unassisted. The two demised fetuses delivered afterwards without difficulty. All fetuses appeared grossly normal. Active management of the third stage and placenta was delivered intact. Perineum was inspected and found to be intact. Abdominal ultrasound was done afterwards, and uterus appeared empty with thin endometrial stripe. Sponge, lap and needle counts were correct.”

Texas Subscriber

Answer: Yes, you would report the delivery with:

• 59410 (Vaginal delivery only (with or without episiotomy and/or forceps); including postpartum care)
• 59409-51 (Vaginal delivery only (with or without episiotomy and/or forceps); Multiple procedures)
• 59409-51

However, of the diagnosis codes listed, you should not report O31.32X0 (Continuing pregnancy after elective fetal reduction of one fetus or more, second trimester, not applicable or unspecified), because this is not a continuing pregnancy for this delivery.

Also, while there are three fetuses, two are not alive at the time of preterm labor, so you are correct in reporting only O60.12; however, the most correct code is O60.12x1 as it is fetus number 1 that is impacted by the preterm labor.

You should only report O09.812 (Supervision of pregnancy resulting from assisted reproductive technology, second trimester) after O30.102 (Triplet pregnancy, unspecified number of placenta and unspecified number of amniotic sacs, second trimester). But remember that information on how many placentas or amnions should be available to you before coding, so always check to ensure you are reporting the most accurate and specific code.

And yes to reporting Z3A.20 (20 weeks gestation of pregnancy) and Z37.61 (Triplets, some liveborn) codes.