LindaS_62015
New member
When a patient delivery is for twin gestation and both amniotic sacs require AROM is the code 10907ZC assigned twice?
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Resolved AROM in Twin Delivery PCS
- Thread starter LindaS_62015
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Lori
Well-known member
I would think twice if it was done twice but I will have Alicia chime in any input she may have as well since it is the same procedure done twice once for each fetus.
Types of multiples
There are three different types of multiple gestations:
ICD-10-PCS Coding Guidelines for Labor Induction
Below represents a summary of Coding Clinic advice for Labor Induction with citations:
A. Oxytocin/Pitocin® when used for Labor Induction should be coded as: 3E033VJ--
Introduction of other hormone into peripheral vein, percutaneous approach
(Coding Clinic 4Q 2014). Note: this code should NOT be used for labor
augmentation with Pitocin (oxytocin), but when oxytocin is used for Labor
Induction it should ALWAYS be used (Coding Clinic 2Q 2014, p9). There is no code
for oxytocin use for Labor Augmentation. Nor is this code used for oxytocin for the
prevention or treatment of postpartum hemorrhage (communication with the
Editor of the Coding Clinics).
B. Cervical Ripening (Labor Induction) using cervical inserts or tablets with
prostaglandins (e.g. Cervidil®, Prepidil®, misoprostol or similar) should be coded
as: 3E0P7GC--Introduction of other therapeutic substance into female
reproductive, via natural or artificial opening. (Coding Clinic, 2Q 2014: Page 8).
This code is NOT used for misoprostol for the prevention or treatment of
postpartum hemorrhage (communication with the Editor of the Coding Clinics).
Recall that cervical ripening is considered an induction even if oxytocin is not used.
C. Cervical Dilators (Labor Induction) using mechanical methods such as a balloon,
digital exam or similar approach should be coded as: 0U7C7ZZ--Dilation of Cervix,
Via Natural or Artificial Opening. Recall that cervical dilation is considered an
induction even if oxytocin is not used. The Joint Commission also accepts 0U7C7DZ-
-Dilation of Cervix with Intraluminal Device, Via Natural or Artificial Opening,
which appears to be an appropriate code but ICD-10-PCS guidelines recommend
that Device codes (6th character=”D”) should only be used when the device is
purposely left in on discharge (communication with the Editor of the Coding
Clinics).
Note that Artificial Rupture of Membranes (AROM) (using a hook thru the cervix, not an
amniocentesis) is coded as: 10907ZC--Drainage of Amniotic Fluid, Therapeutic from
Products of Conception, Via Natural or Artificial opening. This code makes no
distinction between AROM for labor induction or AROM for labor augmentation
(Coding Clinic 2Q 2014, p9). Currently, there is no way to identify a labor induction that
was limited to AROM (with no oxytocin) but this is rare. Well over 95% of AROM are done
to augment labor. Accordingly, the presence of this code without any of the codes above
would be very weak evidence for Induction of Labor and should be confirmed.
The non-specificity of current group of codes (e.g. Introduction of other hormone into
peripheral vein, percutaneous approach) is somewhat unsatisfactory as we are left to guess
the intention of the procedure code. Generally procedure codes are paired with a diagnosis
code that indicates the reason that the procedure was utilized. Discussions are underway
to possibly create diagnosis codes that would describe the type of labor but such a change
would be 1-2 years before endorsement and application. In the meantime, please use the
codes as outlined above
Types of multiples
There are three different types of multiple gestations:
- Monoamniotic/monochorionic (mo/mo): Mo/mo twins share the same amniotic sac and share the same placenta within the uterus. These multiples are always identical, but have two separate umbilical cords.
- Monoamniotic/diamniotic (mono/di): Mono/di twins generally have two amniotic sacs (a fetus in each sac) yet share the same placenta and have separate umbilical cords. These multiples are also identical.
- Dichorionic/diamniotic (di/di): This is the most common form of multiples. These type of twins usually have two amniotic sacs and two placentas. Di/di twins are commonly referred to as fraternal twins. This type of multiple rarely produces identicals.
ICD-10-PCS Coding Guidelines for Labor Induction
Below represents a summary of Coding Clinic advice for Labor Induction with citations:
A. Oxytocin/Pitocin® when used for Labor Induction should be coded as: 3E033VJ--
Introduction of other hormone into peripheral vein, percutaneous approach
(Coding Clinic 4Q 2014). Note: this code should NOT be used for labor
augmentation with Pitocin (oxytocin), but when oxytocin is used for Labor
Induction it should ALWAYS be used (Coding Clinic 2Q 2014, p9). There is no code
for oxytocin use for Labor Augmentation. Nor is this code used for oxytocin for the
prevention or treatment of postpartum hemorrhage (communication with the
Editor of the Coding Clinics).
B. Cervical Ripening (Labor Induction) using cervical inserts or tablets with
prostaglandins (e.g. Cervidil®, Prepidil®, misoprostol or similar) should be coded
as: 3E0P7GC--Introduction of other therapeutic substance into female
reproductive, via natural or artificial opening. (Coding Clinic, 2Q 2014: Page 8).
This code is NOT used for misoprostol for the prevention or treatment of
postpartum hemorrhage (communication with the Editor of the Coding Clinics).
Recall that cervical ripening is considered an induction even if oxytocin is not used.
C. Cervical Dilators (Labor Induction) using mechanical methods such as a balloon,
digital exam or similar approach should be coded as: 0U7C7ZZ--Dilation of Cervix,
Via Natural or Artificial Opening. Recall that cervical dilation is considered an
induction even if oxytocin is not used. The Joint Commission also accepts 0U7C7DZ-
-Dilation of Cervix with Intraluminal Device, Via Natural or Artificial Opening,
which appears to be an appropriate code but ICD-10-PCS guidelines recommend
that Device codes (6th character=”D”) should only be used when the device is
purposely left in on discharge (communication with the Editor of the Coding
Clinics).
Note that Artificial Rupture of Membranes (AROM) (using a hook thru the cervix, not an
amniocentesis) is coded as: 10907ZC--Drainage of Amniotic Fluid, Therapeutic from
Products of Conception, Via Natural or Artificial opening. This code makes no
distinction between AROM for labor induction or AROM for labor augmentation
(Coding Clinic 2Q 2014, p9). Currently, there is no way to identify a labor induction that
was limited to AROM (with no oxytocin) but this is rare. Well over 95% of AROM are done
to augment labor. Accordingly, the presence of this code without any of the codes above
would be very weak evidence for Induction of Labor and should be confirmed.
The non-specificity of current group of codes (e.g. Introduction of other hormone into
peripheral vein, percutaneous approach) is somewhat unsatisfactory as we are left to guess
the intention of the procedure code. Generally procedure codes are paired with a diagnosis
code that indicates the reason that the procedure was utilized. Discussions are underway
to possibly create diagnosis codes that would describe the type of labor but such a change
would be 1-2 years before endorsement and application. In the meantime, please use the
codes as outlined above
Always with PCS you use the code twice. They don't usually have laterality or duplicate built into the code descriptions. However, be very careful that the procedure WAS done twice. For this case, it must be stated in the documentation they did both not just one.
LindaS_62015
New member
Thank you Lori and Alicia for your thorough response, I really appreiciate IT. Yes, there were two sacs and both had AROM prior to the delivery of twin A and B.
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