READER QUESTIONS:
19 Weeks May Mean Mixed Bag
Published on Tue May 03, 2005
Question: Should I use 59400 if the patient was only at 19 weeks and delivered a live baby and a baby who was stillborn? I thought anything before 22 weeks was considered a miscarriage/abortion.
Texas Subscriber
Answer: For coding purposes, you should use a delivery code only when the ob-gyn performs a live birth or the fetus is greater than 20 weeks 0 days gestation. If the pregnancy is younger than that and the fetus is born dead, you should not report a delivery.
In this case, with one twin born dead and the other alive, your codes will be a mixed bag at 19 weeks. You may try to report the global service (59400, Routine obstetric care including antepartum care, vaginal delivery [with or without episiotomy, and/or forceps] and postpartum care) with modifier -52 (Reduced services) in this case unless the payer insists on having all services itemized.
If that's the case, you should report only one delivery using 59409 (Vaginal delivery only [with or without episiotomy and/or forceps]) for twin B.
Don't forget: You would report the admission and E/M care involved with twin A for the spontaneous abortion. Of course, be sure to send in the documentation about what happened in either case.
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