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Ob-Gyn Coding Alert

Reader Question:

ICD-10 Will Solve This Fetal Demise Diagnosis Issue

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 SubscriberAnswer: 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 [...]