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Posted By mary peabody on 07-19-2019, 20:46:39 in Ob-Gyn
How would you code a quadruplet pregnancy and one fetus demise.? When coding 031.31X_ , should the 7th digit represent the fetus that is demise or the fetus/s that are living? Example: 031.21X1, 031.21X2, 031.21X3, 030.201

Gestational age based on patient's reported EDC of 7/10/2019 is 10 weeks
Ultrasound Report: On ultrasound performed today, there is a living
triplet gestation. A fourth, nonviable fetus was noted in the upper uterus
There are 3 chorions, and 3 amnions, and the CRLs are: Triplet A: 40.4 mm, Triplet
B:41.0 mm, and Triplet C: 39.5 mm. This is consistent with her clinical
gestational age of 10 weeks 5 days and an EDC of 7/10/2019. The uterus
and cervix were unremarkable. A simple unilocular right ovarian cyst was
Comments (2)
Posted By Melanie Witt on 04-20-2020, 16:16:21
So I just got an answer to the question I posed to the AHA Coding Clinic: can you believe it took them 8 months to get to it??? Anyway, as I had previously stated, the pregnancy is still considered a quadruplet pregnancy. And you code for fetus who impacted the care, not the remaining fetuses. So in this case it would be O31.21x4 and O30.2__ for the quadruplet pregnancy.
Posted By Melanie Witt on 07-24-2019, 14:42:52
This is a very interesting question. Per ICD10 guidelines you assign the 7th digit for the affected fetus, but in the case of the O31 codes, the theme is continuing pregnancy so I would interpret this to mean you report 3 codes for each of the ones that is continuing and add a code O30.231 for the first trimester quadruplet pregnancy. Per ICD9 guidelines (but not mentioned in ICD10) a multiple gestation pregnancy with all retained is still that type of pregnancy. So even though one is no longer alive the pregnancy is still considered a quadruplet pregnancy. This would also be a very good question to ask the AHA Coding Clinic and if you don't mind, I will submit it to them for their opinion.
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