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Michelle Posted Tue 24th of April, 2012 12:55:23 PM

Outpatient, 16 week fetal demise vaginally delivered after laminaria was administered. How do I bill properly for this? Per research you are unable to bill for a delivery for a fetal demise until the fetus is 20 weeks.

SuperCoder Answered Tue 24th of April, 2012 14:35:37 PM

Correct Method of Billing for 16 week Fetal Demise
The global obstetric package code would not be appropriate to bill in the case where the fetus died in utero prior to 20 weeks, zero days gestation. In this case, you will bill the total number of antepartum visits using the methods outlined in CPT. Meaning if she was seen only one, two or three times, each visit is billed using an evaluation and management (E/M) outpatient code (99241-99245).

If she was seen up to six times, 59425 (antepartum care only; 4-6 visits) would be reported, but using only a quantity of one. If she was seen seven or more times, 59426 (antepartum care only; 7 or more visits) would be reported instead. Again, the quantity would be one. CPT also has a code that specifically describes the delivery performed on this patient. The code 59856 (induced abortion, by one or more vaginal suppositories with or without cervical dilation, including hospital admission and visits, delivery of fetus and secundines; with dilation and curettage and/or evacuation) is used when the physician induces abortion (which is the case even with fetal demise) using vaginal suppositories and then goes on to do a D&C for retained placenta.
This code includes the hospital admission, the delivery and surgery following it, and follow-up inpatient hospital visits through discharge. Under the Medicare RBRVS fee schedule, the code also has a 90-day global period, so outpatient follow-up for the delivery and surgery also will be included. But private payers may have assigned a different global period, perhaps lasting only six weeks.

Lisa Answered Thu 26th of April, 2012 15:57:56 PM

My question is 59856 is stated in CPT code book as induced abortion by 1 or more supporsitories w or w/o cx dilation. It does not state used with a missed ab anything before 20 weeks gest. They donot list 632 code in any of IC9-9 code choices in ob/gyn coding companion book. Why do they not have a seperate CPT procedure for Treatment of missed ab non surgically 2nd trimester. This code I consider more like elective ab. especially when you look at code description 59841, 59850 using same term induced ab. and read the definition in the medical term book they are two totally seperate things.

SuperCoder Answered Fri 27th of April, 2012 06:38:47 AM

Hi Lisa,
I absolutely agree on your question. You are asking fetal demise, 16 weeks, missed abortion. I did not get any code for that and I had given an example of 59856 for induced abortion by vaginal suppositories. Throughout the book, we have several codes, but did not get a code related to your query. Just a note for all ABORTION CODES in the CPT manual. I think, you should bill E/M antepartum care codes based upon the visits. However, I am forwarding your query to the respective editor, Suzanne Leder, and she will reply if she has anything on your query.
Surgical management (i.e., D&C or D&E) of incomplete abortion. Defined by ACOG as the expulsion of some products of conception with the remainder evacuated surgically: 59812.
Surgical management (i.e., D&C or D&E) of missed abortion. Defined by ACOG as a pregnancy containing an empty gestational sac, a blighted ovum, or a fetus or fetal pole without a heartbeat prior to 20 weeks 0 days gestation.
Prior to 14 weeks 0 days gestation: 59820.
14 weeks 0 days gestation to prior to 20 weeks 0 days gestation: 59821.
After 20 weeks 0 days: 59821-22 (the 22 is used to indicate the increased difficulty of the procedure after 20 weeks).
Septic abortion treatment by surgically, 59830
Induced abortion via D&C or D&E (without hospital admission and labor).
Prior to 14 weeks 0 days: 59840.
14 weeks 0 days to prior to 20 weeks 0 days: 59841.
20 weeks 0 days or more by D&E: 59841-22.
Induced abortion via intra-amniotic injections, with hospital admission, visits and delivery.
Prior to 20 weeks 0 days gestation: 59850-59851.
Can be used whether or not fetus has heartbeat prior to delivery.
After 20 weeks 0 days, report maternity care and delivery codes: 59400-59515.
Failed intra-amniotic injection with hysterotomy--59851
Induced abortion via vaginal suppositories/cervical dilation, with hospital admission, visits and delivery.
Prior to 20 weeks 0 days gestation: 59855-59857. Can be used whether fetus does or does not have heartbeat prior to delivery. After 20 weeks 0 days gestation, report the maternity care and delivery codes: 59400-59515.
Medical management of pregnancy using other medical induction agents, and medical management of complete spontaneous abortion. Prior to 20 weeks 0 days gestation: 99201-99233 (+ 59812 if surgical intervention is necessary to remove the placenta after delivery of the fetus).
Vaginal or cesarean delivery (with or without induction of labor, any method).
20 weeks 0 day’s gestation or more: 59400-59515. Modifier -52 (reduced services) may be appropriate when the number of antepartum visits is substantially less than 13.

SuperCoder Answered Mon 30th of April, 2012 06:00:43 AM

Hi Lisa,
Below is the answer for your query that I have got from my respective editor:
"You may not bill for a delivery of a fetus that is less than 20 weeks 0 days. Your choices are surgical removal or allowing the patient to go into labor and deliver. If she spontaneously delivers the dead fetus you code only E/M services (admission, subsequent care and discharge management) even if you start IV Pit to get the labor started. If the fetus is removed surgically you code 59820. If labor is induced by the MD using vaginal suppositories and cervical dilators, you report 59855."

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