How to code for an interval delivery in twins
Twin gestations may deliver on the same day or there may be a time interval between the delivery of the first and second twins. Which ICD-10 to associate with the delivery will depend on whether the twins are delivered on the same day or on separate days, and whether they are both born alive or if one (or both) twin(s) is stillborn. In general:(1) the twin type diagnosis is primary,(2) the etiology or indication for delivery secondary, and(3) whether born alive or stillbirth tertiary.The O31 series of codes describes complications specific to multiple gestation. In particular, ICD-10 codes (O31.10X0-O31.33X9) are specific to gestations complicated by spontaneous abortion, intrauterine demise, or reduction of one or more fetuses. The Z37 series of codes describes outcome of delivery (alive or stillbirth).Following are different scenarios that help delineate ICD-10 choice to associate with those deliveries.
1. If the twins are delivered alive on the same day:
• Twin type - O30 series (Primary)
• Reason the patient went into labor or was delivered, e.g. : PROM, preeclampsia, etc. (Secondary)
• Z37.2 (Tertiary)
2. If one twin is delivered alive and the other stillbirth (known IUFD) on the same day:
• Twin type - O30 series (Primary)
• Reason the patient went into labor or was delivered, e.g. : PROM, preeclampsia, etc. (Secondary)
• Z37.3 (Tertiary)
3. If both twins are stillbirth and delivered on the same day:
• Twin type - O30 series (Primary)
• Reason the patient went into labor or was delivered, e.g. : PROM, preeclampsia, etc. (Secondary)
• Z37.4 (Tertiary)
For examples 2 & 3, one may use the O31.2 series (continuing pregnancy after intrauterine death of one fetus or more) for prenatal E&M visits after the IUFD is diagnosed.
In cases when the twins are not delivered on the same day, different ICD-10 diagnoses may be associated with the delivery of the first and second twins. This is also affected by whether the twins are born alive or not. For example:
4. If the twins are delivered alive on 2 separate days, the delivery of the first twin is associated with the following ICD-10:
• Twin type - O30 series (Primary)
• Reason the patient went into labor or was delivered, e.g. : PROM, preeclampsia, etc. (Secondary)
• Z37.0 (Tertiary)
The delivery of the second twin is associated with the following ICD-10:
• O63.2 Delayed delivery of second twin (Primary)
• Reason the patient went into labor or was delivered, if present, e.g. : PROM, preeclampsia, etc. (Secondary)
• Z37.0 (Tertiary)
Please note that currently, there is no ICD-10 code to associate with E&M visits when one twin is delivered alive and delayed delivery isanticipated for the surviving second twin.