--- title: ICD-10-CM Coding for Malposition/Malpresentation of Fetus description: Optimal fetal positioning makes labor and delivery faster, easier and safer for both the fetus and the mother. Fetal malposition or malpresentation may lead to difficulties with labor and delivery and can be an indication for as assisted vaginal birth or delivery by cesarean section. image: https://hiacode.com/hubfs/iStock-1371702934.jpg --- # ICD-10-CM Coding for Malposition/Malpresentation of Fetus ![Cari Greenwood, RHIA, CCS, CPC](https://hiacode.com/hubfs/Cari%20Greenwood%20Author%20Bio%20(1).png) [Cari Greenwood, RHIA, CCS, CPC](https://hiacode.com/blog/author/cari-greenwood) Mar 27, 2024 [Industry News](https://hiacode.com/blog/tag/industry-news) [Medical Coding Tips](https://hiacode.com/blog/tag/medical-coding-tips) ![ICD-10-CM Coding for Malposition/Malpresentation of Fetus](https://hiacode.com/hubfs/iStock-1371702934.jpg) - Share on: - [![](https://hiacode.com/hubfs/Facebook%20svg.svg)](http://www.facebook.com/share.php?u=https://hiacode.com/blog/icd-10-cm-coding-for-malposition-malpresentation-of-fetus) - [![](https://hiacode.com/hs-fs/hubfs/twitter.png?width=32&height=32&name=twitter.png)](https://twitter.com/intent/tweet?text=I+found+this+interesting+blog+post&url=https://hiacode.com/blog/icd-10-cm-coding-for-malposition-malpresentation-of-fetus) - [![](https://hiacode.com/hubfs/LinkedIn%20svg.svg)](http://www.linkedin.com/shareArticle?mini=true&url=https://hiacode.com/blog/icd-10-cm-coding-for-malposition-malpresentation-of-fetus) - [![](https://hiacode.com/hubfs/mdi_email.svg)](mailto:?subject=Check%20out%20https://hiacode.com/blog/icd-10-cm-coding-for-malposition-malpresentation-of-fetus%20&body=Check%20out%20https://hiacode.com/blog/icd-10-cm-coding-for-malposition-malpresentation-of-fetus&media=https://learn.hiacode.com/hubfs/iStock-1371702934.jpg) - ![](https://hiacode.com/hubfs/entypo_link.svg) copied Fetal positioning within the uterus is not of much concern until the third trimester which is when most fetuses assume a head down position in preparation for descent into the birth canal. Optimal fetal positioning makes labor and delivery faster, easier and safer for both the fetus and the mother. Fetal malposition or malpresentation may lead to difficulties with labor and delivery and can be an indication for as assisted vaginal birth or delivery by cesarean section. Proper code assignment for malposition and malpresentation is necessary to support performance of these procedures for these conditions. ## What is Fetal Presentation, Position and Lie? Fetal presentation, position and lie describe the fetus in relation to the uterus, cervix and maternal pelvis. - **Fetal presentation** refers to the part of the fetus that is lined up to enter the maternal pelvis first/lead the fetus through the cervix (e.g., occiput, chin, shoulder, foot). - **Fetal position** refers to the position of the fetal head as it exits the birth canal. This indicates the direction the fetus is facing (anterior, posterior, transverse). - **Fetal lie** refers to how the long axis of the fetus (think spinal column) lines up in relation to the uterus. The lie can be longitudinal (straight up and down), oblique (diagonal) or transverse (sideways).  Normal or optimal presentation, position and lie for vaginal obstetric delivery is: - **Presentation: **Vertex/cephalic (the crown of the head) with chin tucked to chest and arms crossed over the chest - **Position:** Occiput anterior (the baby is facing toward the mother’s spine) - **Lie: **Longitudinal (straight up and down). ## What is Malpresentation/Malposition? Malpresentations and malpositions result when one or a combination of the fetal presentation, position or lie deviates from the normal/optimal status. Below are examples of malpresentations, malpositions, and abnormal lie. Malpresentation - **Breech:** The buttocks and/or feet are the presenting part of the fetus - **Frank breech:** Buttocks down with feet near the head - **Complete breech: **Knees bent with feet near the buttocks - **Incomplete breech: **One knee bent with one foot near the buttocks - **Footling breech: **One or both feet are the presenting part - **Face/Brow/Chin (mentum): **The fetus’ neck is hyperextended (arched) making the face, brow or chin the presenting fetal part. The degree of hyperextension determines which part is presenting. Greater extension presents the face/chin, less extension presents the brow. - **Shoulder/arm:** The shoulder or arm is the presenting part of the fetus - **High head at term: **The fetal head does not engage in the pelvis - **Compound: **A fetal extremity presents alongside the part of the fetus closest to the birth canal (e.g., hand/arm presents alongside the head) Malposition - **Occipitoposterior:** The fetus’ occiput (back of the head) is against the posterior (spinal) side of the mother and the fetus is facing toward the mother’s abdomen. This is sometimes referred to as “sunny side up”. - **Occipitotransverse:** This position is halfway between an anterior and a posterior position. The side of the fetus is perpendicular to the mother’s spine and the fetus is facing outward toward the mother’s right or left thigh.  Abnormal Lie - **Oblique:** The fetus is lying diagonally. - **Transverse: **The fetus is lying sideways. - **Unstable: **The fetus does not maintain a fixed longitudinal lie after 36 weeks gestation. ## How is Malpresentation/Malposition Coded in ICD-10-CM? Codes for malpresentation and/or malposition of fetus are found in category** O32 Maternal care for malpresentation of fetus.** Notice that the description of each code specifies that the code is used to report maternal care for a specific type of malpresentation/malposition. **032.0 Maternal care for unstable lie** 032.1 Maternal care for breech presentation - Maternal care for buttocks presentation - Maternal care for complete breech - Maternal care for frank breech - **Excludes 1: **footling presentation (032.8); incomplete breech (032.8) **032.2 Maternal care for transverse and oblique lie** - Maternal care for oblique presentation - Maternal care for transverse presentation 032.3 Maternal care for face, brow and chin presentation 032.4 Maternal care for high head at term - Maternal care for failure of head to enter pelvic brim **032.6 Maternal care for compound presentation** 032.8 Maternal care for other malpresentation of fetus - Maternal care for footling presentation - Maternal care for incomplete breech 032.9 Maternal care for malpresentation of fetus, unspecified Assignment of codes is determined by a applying a combination of direction found in the Alphabetic Index, the Tabular List and the ICD-10-CM official guidelines to the documentation in the medical record. ## The Alphabetic Index Selection of the correct code to report malpresentation/malposition is directed by a valid search of the Index to Diseases and Injuries. There are several ways the index can be searched to arrive at codes for malpresentation/malposition depending on the terminology used in the documentation. Successful searches include: **Delivery **** cesarean (for) **    breech presentation O32.1    chin presentation O32.3    high head at term O32.4     Etc. **Delivery ****   complicated ****      by ****         malposition, malpresentation ****            without obstruction ****               **breech O32.1                 compound O32.6                 face (brow) (chin) O32.3                 footling O32.8       high head O32.4      oblique O32.2      specified NEC O32.8      transverse O32.2      unstable lie O32.0 **Delivery ****   complicated ****      by ****         prolapse ****            **arm or hand O32.2              foot or leg O32.8 **Failure **** **descent of head (at term) of pregnancy (mother) O32.4   engagement of head (term of pregnancy) (mother) O32.4 **Pregnancy ****   Complicated by ****      **mentum presentation O32.3        oblique lie or presentation O32.2        transverse lie or presentation O32.2        unstable lie O32.0        Etc. **Pregnancy ****   Complicated by ****      **presentation, fetal -see Delivery, complicated by, malposition **Breech presentation (mother) O32.1** **Transverse ****   **lie (mother) O32.2** ** **Unstable ****   **lie (mother) O32.0 **Presentation, fetal** -see Delivery , complicated by, malposition ## **The Tabular List** There are notes at the beginning of category O32 that provide important direction that must be followed when assigning codes from this category. For example: - Codes from this category are assigned when malpresentation/malposition is the reason for maternal care - When malpresentation causes obstructed labor, a code from category O64 is assigned rather than from category O32 - A 7th character that reports the affected fetus is assigned to codes for malpresentation/malposition O32 Maternal care for malpresentation of fetus Includes: the listed conditions as a reason for observation, hospitalization or other obstetric care of the mother, or for cesarean delivery before onset of labor Excludes1: malpresentation of fetus with obstructed labor (064.-) One of the following 7th characters is to be assigned to each code under category 032. 7th character 0 is for single gestations and multiple gestations where the fetus is unspecified. 7th characters 1 through 9 are for cases of multiple gestations to identify the fetus for which the code applies. The appropriate code from category 030, Multiple gestation, must also be assigned when assigning a code from category O32 that has a 7th character of 1 through 9. - 0 - not applicable or unspecified - 1 - fetus 1 - 2 - fetus 2 - 3 - fetus 3 - 4 - fetus 4 - 5 - fetus 5 - 9 - other fetus **Note:**** **Codes from category O32 only have 4 characters, so a placeholder character of “X” is needed in the 5thand 6th character places to ensure the character value assigned to indicate the affected fetus is in the 7thcharacter place. ## The ICD-10-CM Coding Guidelines According to ICD-10-CM Official Guideline I.C.15.b.4 Selection of OB Principal or First-listed Diagnosis When a Delivery Occurs, malpresentation/malposition is sequenced as the principal diagnosis when: - Malpresentation/malposition is the reason for admission. - Malpresentation/malposition and another condition prompt the admission but malpresentation/malposition is most related to the delivery (e.g., it leads to instrumental vaginal delivery or is the reason for admission for cesarean section) - The patient is admitted with no other complications of pregnancy and develops malpresentation/malposition post admission and malpresentation/malposition necessitates maternal care including, but not limited to: repositioning of the patient, rotation of fetal head, internal/external version, instrumental vaginal delivery (forceps/vacuum extraction). In a small number of cases, how the fetus is situated may be a malpresentation/malposition but the malpresentation/malposition does not require maternal care. If this is the case, a code from category O32 is not assigned. **Example:** A patient is admitted in advanced premature labor. The fetus is in vertex presentation, but in occiput posterior position (sunny side up). Due to the small size of the fetus, it is delivered via a normal, spontaneous vaginal delivery in the occiput posterior position. Since the malposition of the fetus did not necessitate maternal care a code from category O32 is not assigned. This is consistent with the coding guidelines for selection of additional or other diagnoses. **Section III. Reporting Additional Diagnoses ** **GENERAL RULES FOR OTHER (ADDITIONAL) DIAGNOSES ** For reporting purposes, the definition for **“other diagnoses**” is interpreted as additional **clinically significant conditions that affect patient care** in terms of requiring: clinical evaluation; or therapeutic treatment; or diagnostic procedures; or extended length of hospital stay; or increased nursing care and/or monitoring ## Malpresentation/Malposition as an Indication for Cesarean Section In cases where vaginal delivery is contraindicated because of malpresentation, malposition or abnormal lie, a cesarean section may need to be performed to deliver the fetus safely. The **Includes note** under **category O32** in the Tabular List indicates codes from this category are intended to be reported when the decision to deliver a patient via cesarean section, secondary to malpresentation or malposition of the fetus, is made **before the onset of labor**. O32 Maternal care for malpresentation of fetus - Includes: the listed conditions as a reason for observation, hospitalization or other obstetric care of the mother, or for cesarean delivery before onset of labor This distinction is important because when a patient presents **in labor** with the intent to delivery vaginally and malpresentation/malposition results in the decision to deliver the patient via cesarean this is typically because the malpresentation/malposition of the fetus has resulted in obstructed labor that precludes vaginal delivery. These circumstances are reported with a code from category **O64 Obstructed labor due to malposition and malpresentation of fetus **rather than with a code from category O32**.** ## Take Aways Malpresentations and malpositions result when one or a combination of the fetal presentation, position or lie deviates from the normal/optimal status. ICD-10-CM codes to report malpresentation/malposition are assigned from category O32** **Maternal care for malpresentation of fetus when the malpresentation/malposition is the reason for maternal care. Code selection is guided by documentation in the medical record and a valid search of the Index to Diseases and Injuries. The ICD-10-CM Tabular List and coding guidelines provide significant direction regarding the requirements and structure for assigning a valid code and sequencing of codes from category O32 as the principal diagnosis. ***References **ICD-10-CM Index to Diseases and Injuries* *ICD-10-CM Official Guidelines for Coding and Reporting* *ICD-10-CM Tabular List* --- Since 1992, HIA has been the leading provider of [compliance audits](https://hiacode.com/acute-review), [coding support services](https://hiacode.com/acute-coding-support) and [clinical documentation audit services ](https://hiacode.com/clinical-documentation-integrity)for [hospitals](https://hiacode.com/hospitals), [ambulatory surgery centers](https://hiacode.com/asc-coding), [physician groups](https://hiacode.com/provider-groups) and other healthcare entities. HIA offers PRN support as well as [total outsource support.](https://hiacode.com/total-outsource-coding) --- [![Now hiring medical coders and medical coding auditors](https://no-cache.hubspot.com/cta/default/20824215/85c79f13-ae12-4dc4-8647-0d5c9302516b.png)](https://cta-redirect.hubspot.com/cta/redirect/20824215/85c79f13-ae12-4dc4-8647-0d5c9302516b)   ##### [Previous](https://hiacode.com/blog/education/icd10-tip-pacemakeraicd-status-vs-management) ### [Pacemaker/AICD Status vs. Management ICD-10-CM Codes](https://hiacode.com/blog/education/icd10-tip-pacemakeraicd-status-vs-management) ##### [Next](https://hiacode.com/blog/healthcon-2024) ### [Health Information Associates to Showcase Expertise and Innovations at AAPC's HealthCon 2024](https://hiacode.com/blog/healthcon-2024) Serach Blog Post ## Need to Earn CEUs? Our coding education platform, HIAlearn.com, offers courses related to this topic and many more. Subscribe today and access more than 230 courses accepted by AHIMA for CEUs, with a selection also accepted by AAPC. ![CTA Sidebar HIAlearn logo-1](https://hiacode.com/hs-fs/hubfs/CTA%20Sidebar%20HIAlearn%20logo-1.png?width=1080&height=189&name=CTA%20Sidebar%20HIAlearn%20logo-1.png) [![Learn More](https://no-cache.hubspot.com/cta/default/20824215/f611164b-1c02-4b86-a2aa-6033633d4569.png)](https://cta-redirect.hubspot.com/cta/redirect/20824215/f611164b-1c02-4b86-a2aa-6033633d4569) #### Category - [Medical Coding Tips (370)](https://hiacode.com/blog/tag/medical-coding-tips) - [Industry News (339)](https://hiacode.com/blog/tag/industry-news) - [Company News (23)](https://hiacode.com/blog/tag/company-news) - [Query Tips (23)](https://hiacode.com/blog/tag/query-tips) - [Annual Code Updates (16)](https://hiacode.com/blog/tag/annual-code-updates) - [CDI Tips (9)](https://hiacode.com/blog/tag/cdi-tips) ### Subscribe to our Newsletter #### Recent Blogs Jul 01, 2026 [Industry News](https://hiacode.com/blog/tag/industry-news) [Medical Coding Tips](https://hiacode.com/blog/tag/medical-coding-tips) ### [ICD-10-CM Coding for Colonosco...](https://hiacode.com/blog/icd-10-cm-coding-for-colonoscopy-following-positive-cologuard-result) Jun 24, 2026 [Industry News](https://hiacode.com/blog/tag/industry-news) [Medical Coding Tips](https://hiacode.com/blog/tag/medical-coding-tips) ### [20,000 Inpatient Reviews Revea...](https://hiacode.com/blog/20k-inpatient-coding-reviews-principal-diagnosis-pcs-revenue-integrity) Jun 10, 2026 [Industry News](https://hiacode.com/blog/tag/industry-news) [Medical Coding Tips](https://hiacode.com/blog/tag/medical-coding-tips) ### [Big Changes Coming to CPT Codi...](https://hiacode.com/blog/big-changes-coming-to-cpt-coding-for-maternity-care) Jun 05, 2026 [Industry News](https://hiacode.com/blog/tag/industry-news) [Medical Coding Tips](https://hiacode.com/blog/tag/medical-coding-tips) ### [Why Being Proactive Matters in...](https://hiacode.com/blog/proactive-coding-quality-assurance) ## Related blogs from Industry News , Medical Coding Tips Jul 01, 2026 [Industry News](https://hiacode.com/blog/tag/industry-news),  [Medical Coding Tips](https://hiacode.com/blog/tag/medical-coding-tips) #### [ICD-10-CM Coding for Colonoscopy Following Positiv...](https://hiacode.com/blog/icd-10-cm-coding-for-colonoscopy-following-positive-cologuard-result) A colonoscopy prompted by a positive Cologuar... [ Read More](https://hiacode.com/blog/icd-10-cm-coding-for-colonoscopy-following-positive-cologuard-result) Jun 24, 2026 [Industry News](https://hiacode.com/blog/tag/industry-news),  [Medical Coding Tips](https://hiacode.com/blog/tag/medical-coding-tips) #### [20,000 Inpatient Reviews Reveal Coding Opportuniti...](https://hiacode.com/blog/20k-inpatient-coding-reviews-principal-diagnosis-pcs-revenue-integrity) A review of 20,805 inpatient encounters found... [ Read More](https://hiacode.com/blog/20k-inpatient-coding-reviews-principal-diagnosis-pcs-revenue-integrity) Jun 10, 2026 [Industry News](https://hiacode.com/blog/tag/industry-news),  [Medical Coding Tips](https://hiacode.com/blog/tag/medical-coding-tips) #### [Big Changes Coming to CPT Coding for Maternity Car...](https://hiacode.com/blog/big-changes-coming-to-cpt-coding-for-maternity-care) Beginning January 1, 2027, CPT will retire th... [ Read More](https://hiacode.com/blog/big-changes-coming-to-cpt-coding-for-maternity-care) Jun 05, 2026 [Industry News](https://hiacode.com/blog/tag/industry-news),  [Medical Coding Tips](https://hiacode.com/blog/tag/medical-coding-tips) #### [Why Being Proactive Matters in Coding Quality Assu...](https://hiacode.com/blog/proactive-coding-quality-assurance) Taking a proactive approach to coding quality... [ Read More](https://hiacode.com/blog/proactive-coding-quality-assurance) ## Subscribe to our Newsletter Weekly medical coding tips and coding education delivered directly to your inbox. ```json { "@context" : "https://schema.org", "@type" : "BlogPosting", "author" : { "@type" : "Person", "name" : "Cari Greenwood, RHIA, CCS, CPC", "url" : "https://hiacode.com/blog/author/cari-greenwood" }, "dateModified" : "2024-03-27T16:24:04.281Z", "datePublished" : "2024-03-27T15:54:32.000Z", "headline" : "ICD-10-CM Coding for Malposition/Malpresentation of Fetus", "image" : [ "https://hiacode.com/hubfs/iStock-1371702934.jpg" ], "mainEntityOfPage" : { "@id" : "https://hiacode.com/blog/icd-10-cm-coding-for-malposition-malpresentation-of-fetus", "@type" : "WebPage" }, "publisher" : { "@type" : "Organization", "logo" : { "@type" : "ImageObject", "url" : "https://hiacode.com/hubfs/HIA_RGB_AlternativeLogo%20(1)%20(1).png" }, "name" : "Health Information Associates" } } ``` ```json { "@context" : "http://schema.org", "@type" : "BlogPosting", "author" : { "@type" : "Person", "name" : "Pat Maccariella-Hafey, RHIA, CDIP, CCS, CCS‑P, CIRCC", "url" : "https://hiacode.com/blog/author/pat-maccariella-hafey" }, "dateModified" : "2023-02-01", "datePublished" : "2017-03-30", "description" : "VATS is an abbreviation for “video assisted thoracic surgery.” VATS is a minimally invasive surgical technique used to diagnose and treat problems in organs within the thorax such as the lungs and pleura.", "headline" : "Video Assisted Thoracoscopic Surgery Approach Value", "image" : "https://20824215.fs1.hubspotusercontent-na1.net/hubfs/20824215/Imported_Blog_Media/About-Health-Information-Associates-HIAcode-May-12-2022-07-02-15-63-PM.jpg", "mainEntityOfPage" : { "@id" : "https://hiacode.com/blog/education/video-assisted-thoracoscopic-surgery-approach-value", "@type" : "WebPage" }, "publisher" : { "@type" : "Organization", "logo" : { "@type" : "ImageObject", "height" : "60", "url" : "https://hiacode.com/hubfs/Logos/Health%20Information%20Associates%20Medical%20Coding%20Company.png", "width" : "60" }, "name" : "Health Information Associates" }, "url" : "https://hiacode.com/blog/education/video-assisted-thoracoscopic-surgery-approach-value" } ``` ```json { "@context" : "http://schema.org", "@type" : "Article", "author" : { "@type" : "Person", "name" : "Pat Maccariella-Hafey, RHIA, CDIP, CCS, CCS‑P, CIRCC", "url" : "https://hiacode.com/blog/author/pat-maccariella-hafey" }, "dateModified" : "2023-02-01", "datePublished" : "2017-03-30", "description" : "VATS is an abbreviation for “video assisted thoracic surgery.” VATS is a minimally invasive surgical technique used to diagnose and treat problems in organs within the thorax such as the lungs and pleura.", "headline" : "Video Assisted Thoracoscopic Surgery Approach Value", "image" : "https://20824215.fs1.hubspotusercontent-na1.net/hubfs/20824215/Imported_Blog_Media/About-Health-Information-Associates-HIAcode-May-12-2022-07-02-15-63-PM.jpg", "mainEntityOfPage" : { "@id" : "https://hiacode.com/blog/education/video-assisted-thoracoscopic-surgery-approach-value", "@type" : "WebPage" }, "publisher" : { "@type" : "Organization", "logo" : { "@type" : "ImageObject", "height" : "60", "url" : "https://hiacode.com/hubfs/Logos/Health%20Information%20Associates%20Medical%20Coding%20Company.png", "width" : "60" }, "name" : "Health Information Associates" }, "url" : "https://hiacode.com/blog/education/video-assisted-thoracoscopic-surgery-approach-value" } ```