Coding, Classification & Reimbursement

Pregnancy - OB

  • 1.  Pregnancy - OB

    Posted 9 days ago
    I would like responses on this icd 10 dx code 
    Continuing pregnancy after spontaneous abortion of one fetus or more, first trimester

    When there is a twin or triplet pregnancy and one of the fetus is either reduced or aborted are your the above code to reflect the viable fetuses or the demise fetus?

    Sharmilla Rabin
    Medical Billing Specialist

  • 2.  RE: Pregnancy - OB

    Posted 9 days ago
    Edited by Andrea Wong 9 days ago
    O31.11- (Continuing pregnancy after spontaneous abortion of one fetus or more, first trimester) is an incomplete code that requires a 7th character to “identify the fetus for which the code applies”, per the tabular category requirement.

    O31.11x#- is a circumstantial code that indicates a pregnancy was originally a multiple gestation, but is now reduced, and the mother is still in continued pregnancy.

    If multiple fetuses were affected by the spontaneous abortion, than multiple codes are assigned for each specific fetus affected, or in other words, spontaneously aborted at or before 20 weeks of gestation. Note that there exists a O31.2- code for an intrauterine death, which is defined as “death that occurs after completion of 20 weeks”, so be meticulous when assigning the correct category between O31.1- and O31.2-.

    The collection of codes is what tells the story of the patients circumstance. O31.11x# alone does not indicate how many fetuses were originally present before the reduction, so the code is routinely combined with a code for multiple gestation in category O30- to indicate the original number of fetuses, and original chorionic/amniotic sacs into one combination code, with the assignment of 5th character for the current trimester that the patient received care. The combination of O31.11x# and O30- allows the coding auditor logically deduce the remaining number of viable fetus(es).

    O31.11x# will continue to be used to indicate which fetus was spontaneously aborted, in both first time and subsequent encounters, even if the fetus is no longer remaining on a subsequent encounter, because the pregnancy is considered high risk, and needs to be identified for reporting.

    It’s also important to note that although the weeks of gestation (Z3A-) are not normally assigned for conditions with abortive outcomes in categories (O00-O08), Z3A- weeks, is still coded as a secondary diagnosis when using O31.11x# because the patient is still pregnant per the code description.

    When a mother delivers in a hospital and it is a viable delivery, an outcome of delivery code is used. The actual number of live-born babies 👶 delivered during the encounter will be coded, not the original number of multiples. So if mom had (originally) twins, Z37.0 would be used for single live-born. If she had originally triplets, and 2 live-borns delivered, Z37.2 for twins would be coded.

    I hope this information clarifies any confusion you had with O31.11x#. Happy coding.

    Andrea Wong

  • 3.  RE: Pregnancy - OB

    Posted 8 days ago

    Your explanation to answer Sharmilla's question is spot on. I wish there were a gazillion professionals like you!

    Happy coding!

    Kelly Randell
    Inpatient Auditor