Betty Posted Fri 13th of September, 2019 15:01:04 PM
I have a patient that we saw on call in the hospital and was dx with single stillbirth and the Dr on call initiated the delivery... temination of pregnancy dx O04.80, O02.1,Z37.1 and Z3A18 in that order with the procedure code of 59856. Insurance has denied payment due to will not pay for abortions. is this the proper was to code this situation? thanks for your review and help
SuperCoder Answered Mon 16th of September, 2019 05:54:46 AM
Hope you are doing good.
In CPT 59856 global procedure, the provider terminates a pregnancy by inserting vaginal suppositories to induce labor contractions and may also insert a laminaria to dilate the cervix. In this service, the patient fails to abort the fetus or the placenta and the provider performs a surgical removal of the fetus and or the placenta. The provider admits the patient to the hospital, inserts the drug and cervical dilator, manages the labor that follows, and then performs the dilation and curettage. The provider then follows the patient in the hospital until discharge. Providers use this method usually after the first trimester, or fourteen weeks and zero days gestation or more. Also, diagnosis for (Induced) termination of pregnancy with unspecified complications, Missed abortion, Single stillbirth and 18 weeks gestation of pregnancy are appropriate to match with the procedure code. Hope you have mentioned the medical necessity for the Induced Abortion. The codes selection seems appropriate. Since, insurance has denied payment with reason "abortions will not paid", then this might be clause in their policy. Because they did not mention any issue in the coding pattern, it is suggested to check the explanation of benefit (EOB) of the denial and find out the exact reason of denial, fulfil it and re-bill the claim. On the other hand, if it is written that abortions will not be paid, then check the payer policy and bill accordingly.
Hope this helps!