This is a follow up to our post last month about 7th character designations for episode of care. The use of 7th character designations is one of the main differences that sets ICD-10-CM apart from ICD-9-CM. These character designations provide some of the additional specificity and detail for which ICD-10-CM is so well-known. This month we’ll describe the use of 7th character designations in ICD-10 diagnosis codes that add specificity and detail to the coding of select obstetric diagnoses.
In ICD-10-CM, categories of codes from the obstetric chapter that report diagnoses or circumstances impacted by whether the pregnancy consists of multiple gestations (twins, triplets, etc.) have been expanded to include 7th character designations that identify the fetus the code applies to.
For example, if a patient requires a cesarean section because one of her twin fetuses is breech, code O32.1XX-. Maternal care for malpresentation of fetus would be assigned with the “-“ being replaced with a number from “0” thru “2” depending on which fetus is breech. The Xs are placeholder characters that ensure the number identifying which fetus is assigned as the 7th character in the code.
Designations available for multiple gestations include:
0 = not applicable or unspecified
1 = fetus 1
2 = fetus 2
3 = fetus 3
4 = fetus 4
5 = fetus 5
9 = other fetus
7th character “0” is for single gestations and multiple gestations where the fetus to which the code applies is unspecified.
Multiple gestation pregnancies with more than 5 fetuses use the 7th character designation of “9” for any fetus beyond 5.
For more information on 7th character extensions and other differences in ICD-10-CM review CMS’ ICD-10-CM Classification Enhancements.