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Anesthesia Coding Alert

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01965 Versus 00940 for Spontaneous Abortion

Published on Wed Nov 17, 2010

Question: Our provider documented that he performed a D&C for an incomplete abortion. We reported CPT 00940 with diagnosis ICD-9 637.91, but the payer denied the claim and said we needed a consent form because of the abortion. When we double checked, we saw that the case was actually a spontaneous abortion, which doesn't need a consent form. We've had trouble with both 00940 and 01965 in these situations; is the problem with our diagnosis coding since the documentation doesn't specify "spontaneous"?Answer: Your problem could lie partly with the diagnosis, but the procedure code might also be off track. Keep these points in mind the next time you code a similar case:You shouldn't report 00940 (Anesthesia for vaginal procedures [including biopsy of labia, vagina, cervix, or endometrium]; not otherwise specified) for D&Cs with abortion. Instead, report 00940 only when the physician performs a D&C.When coding for a spontaneous abortion, look [...]
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