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Delivery after 19 weeks and subsequent fetal demise

Loni Posted Tue 28th of January, 2020 18:05:18 PM
Please advise how to code the following: After four prenatal visits, the patient spontaneously went into labor with twins at 19 weeks. Both babies were live births, but expired after. No induction---the mother went into labor on her own. How are these services to be billed? Please provide coding and any modifiers for the 4 prenatal visits, the delivery and subsequent care. Thank you!
SuperCoder Answered Wed 29th of January, 2020 03:34:09 AM

Hi Loni,

 

You may not bill for a delivery of a fetus that is less than 20 weeks 0 days.

 

Patient spontaneously delivered the fetus which expired after some time, you should code only E/M codes. You should code appropriate In-patient admission code from the code range (99221-99223) for admission followed by appropriate inpatient subsequent care codes (99231-99233) for subsequent day stays and finally appropriate discharge code (99238-99239) for the discharge.

 

For four Pre-natal visits - you should code CPT 59425.

 

Thanks!

Loni Posted Wed 29th of January, 2020 12:18:33 PM
Please see below - which is correct? This is from "Ask an Expert" dated March 2016. My scenario also dealt with a live delivery.... out come of delivery Tammy Posted Tue 08th of March, 2016 15:54:54 PM The infant was alive when born but was only 19 weeks so it was a fetal demise. What is the correct outcome of delivery code?: Z37.1 (still birth) or Z37.0? thanks! Infant alive upon delivery. Perineum: Intact Placenta/Umbilical Cord: Delivered intact, Normal 3-vessel cord Gestation-Completed Weeks: 19 weeks Risk Factors of Labor: Precipitous, Premature Risk Factors-Labor & Delivery: Other (preterm, premature delivery) Mother's Choice of Feeding Met: Not Applicable (Fetal Demise) SuperCoder Answered Wed 09th of March, 2016 05:56:08 AM Hi, Anytime there is a live birth, no matter the gestational age, you would report it as a delivery assuming it was not initially an elective termination procedure.You would now be reporting Z37.0 code for the outcome. If this had been an elective termination (which you have indicated it was not) you would be coding the attempted termination as a procedure, not the delivery. But in this case the patient spontaneously delivered early and the baby was born with a heart beat. You should therefore code this as a global ob procedure but add a modifier -52 (assuming you provided all of her care to date) as you will have provided substantially less care than is valued in the global code.
SuperCoder Answered Thu 30th of January, 2020 03:28:40 AM

Hi Loni,

 

Please find below links from SuperCoder and AAPC, which clearly state that we cannot bill for delivery specific codes if the fetal age is less than 20 weeks.

 

Even though there was delivery of live fetus followed by fetal demise, we cannot code for delivery specific codes.

 

https://www.supercoder.com/my-ask-an-expert/topic/18-weeks-pprom

 

https://www.supercoder.com/my-ask-an-expert/topic/16-week-fetal-demise-vaginal-delivery

 

https://www.aapc.com/discuss/threads/19-week-delivery-cpt-needed.73207/

 

Thanks!

   

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