ED Coding and Reimbursement Alert

Question: A woman with heavy vaginal bleeding and abdominal cramping presented to the ED. After the history of present illness and exam, the physician ordered an ultrasound that confirmed that she had an incomplete spontaneous abortion. The ED physician removed the retained products with forceps. What is the procedure code for this? Washington Subscriber Answer: It depends on the specific service provided. Typically, the tissue retained after an incomplete spontaneous abortion is located near the opening of the cervix. The physician removes the tissue with a ring forceps. This level of service should be reported with the appropriate E/M code (e.g., 99283, Emergency department visit), depending on the physicians documentation in the patients record. It would be unusual for the ED physician to perform a D&C (57820, Dilation and curettage of cervical stump), which would represent a separately billable service. When the patient requires this type of care after a miscarriage, a gynecologist or obstetrician is usually called in to provide treatment.