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ICD-10 Guide
ICD-10 CodesO31.13

O31.13

Billable

Continuing pregnancy after spontaneous abortion of one fetus or more, third trimester

BILLABLE STATUSYes
IMPLEMENTATION DATEOctober 1, 2015
LAST UPDATED09/08/2025

Code Description

ICD-10 O31.13 is a billable code used to indicate a diagnosis of continuing pregnancy after spontaneous abortion of one fetus or more, third trimester.

Key Diagnostic Point:

O31.13 refers to a clinical scenario where a pregnancy continues after the spontaneous abortion of one or more fetuses during the third trimester. This situation is particularly complex in cases of multiple gestations, where the loss of one or more fetuses can lead to various complications for the remaining fetus(es). The risk of complications such as twin-to-twin transfusion syndrome (TTTS) is heightened, especially in monochorionic twin pregnancies. TTTS occurs when blood flow between twins is imbalanced, leading to one twin receiving too much blood (recipient) and the other too little (donor). This condition can result in significant morbidity for both fetuses, including heart failure, growth restriction, and even fetal demise. Management of such pregnancies requires careful monitoring and may involve interventions such as laser therapy to correct the vascular connections between the twins. The psychological impact on the mother and the need for specialized care further complicate the clinical picture, necessitating thorough documentation and coding to reflect the complexity of care provided.

Code Complexity Analysis

Complexity Rating: High

High Complexity

Complexity Factors

  • Multiple gestation complications
  • Management of twin-to-twin transfusion syndrome
  • Psychological considerations for the mother
  • Need for specialized maternal-fetal medicine interventions

Audit Risk Factors

  • Inadequate documentation of fetal monitoring
  • Failure to document interventions for TTTS
  • Lack of clarity on the number of fetuses and their status
  • Insufficient detail on maternal health and psychological support

Specialty Focus

Medical Specialties

Obstetrics and Gynecology

Documentation Requirements

Detailed records of fetal assessments, maternal health, and any interventions performed.

Common Clinical Scenarios

Management of pregnancies with one or more fetal losses, monitoring for complications in remaining fetuses.

Billing Considerations

Accurate coding requires clear documentation of the number of fetuses, their health status, and any complications.

Maternal-Fetal Medicine

Documentation Requirements

Comprehensive documentation of high-risk factors, interventions, and outcomes.

Common Clinical Scenarios

Complex cases involving TTTS, intrauterine interventions, and close monitoring of fetal well-being.

Billing Considerations

High-risk pregnancies necessitate detailed coding to reflect the complexity of care and interventions.

Coding Guidelines

Inclusion Criteria

Use O31.13 When
  • Official coding guidelines for obstetrics emphasize the importance of documenting the specific circumstances surrounding the pregnancy, including the number of fetuses, gestational age, and any complications
  • Coders should ensure that all relevant details are captured to support the use of O31

Exclusion Criteria

Do NOT use O31.13 When
No specific exclusions found.

Related ICD-10 Codes

Related CPT Codes

59025CPT Code

Fetal monitoring

Clinical Scenario

Used during the management of pregnancies with complications such as TTTS.

Documentation Requirements

Detailed records of fetal heart rate monitoring and assessments.

Specialty Considerations

Obstetricians should document the rationale for monitoring frequency based on fetal health.

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

The transition to ICD-10 has allowed for more specific coding of obstetric conditions, including O31.13, which captures the complexities of managing pregnancies with multiple gestations and complications. This specificity aids in better tracking of outcomes and resource utilization.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of obstetric conditions, including O31.13, which captures the complexities of managing pregnancies with multiple gestations and complications. This specificity aids in better tracking of outcomes and resource utilization.

Reimbursement & Billing Impact

The transition to ICD-10 has allowed for more specific coding of obstetric conditions, including O31.13, which captures the complexities of managing pregnancies with multiple gestations and complications. This specificity aids in better tracking of outcomes and resource utilization.

Resources

Clinical References

  • •
    American College of Obstetricians and Gynecologists (ACOG)

Coding & Billing References

  • •
    American College of Obstetricians and Gynecologists (ACOG)

Frequently Asked Questions

What documentation is necessary for coding O31.13?

Documentation should include details on the number of fetuses, gestational age, any complications such as TTTS, and the interventions performed. Psychological support provided to the mother should also be documented.