Quad preg w two or more monochorionic fetuses, third tri

This code identifies a pregnancy involving four fetuses, where at least two of them share a single chorion, and the pregnancy has advanced into the third trimester. This specific chorionicity carries increased risks for the monochorionic fetuses, such as twin-to-twin transfusion syndrome (TTTS) or selective intrauterine growth restriction (sIUGR).

Apply this code when documentation clearly indicates a quadruplet gestation with at least two fetuses sharing a chorion, and the patient is in the third trimester (28 weeks gestation or greater). Supporting documentation would include ultrasound reports detailing chorionicity and fetal count, as well as physician notes confirming gestational age.

• Always confirm both the number of fetuses (quadruplet) and the chorionicity (two or more monochorionic) from the medical record.
• Ensure the gestational age is explicitly stated as third trimester; otherwise, a different trimester code would be appropriate.
• Sequence this code as a primary diagnosis when it is the focus of care or monitoring during the third trimester.