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Anesthesia Coding Alert

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Clarify Incomplete Abortion With Carrier

Published on Sun Jun 18, 2006

Question: Medicaid denies our claims for incomplete abortion when we report anesthesia code 01965 with surgical code 59812. Medicaid asks for a patient consent form along with the claim, although we're not reporting an elective procedure. How should we handle this?

Massachusetts Subscriber

Answer: The correct code is 01965 (Anesthesia for incomplete or missed abortion procedures). Some coders submit 01965 with a diagnosis of 632 (Missed abortion) but don't include a surgical code such as 59812 (Treatment of incomplete abortion, any trimester, completed surgically).
 
Other coders recommend submitting 00940 (Anesthesia for vaginal procedures [including biopsy of labia, vagina, cervix or endometrium]; not otherwise specified) if the carrier denies 01965. Although the carrier might reimburse for 00940, it is incorrect for reporting an incomplete abortion, so you should not submit it.
 
If Medicaid does not accept 01965, follow the appropriate channels to appeal the claim and include any supporting documentation. Sometimes getting reimbursed for the correct code can be a battle, but you should fight it rather than resubmit with an inappropriate code.
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