Ob-Gyn Coding Alert

Question: My ob-gyn saw a patient who had a spontaneous delivery at 17 weeks. Then, she returned to the OR for a dilation and curettage (D&C) for retained products. Four days later, the patient came into office with heavy bleeding. The ob-gyn performed an ultrasound and discovered patient still had retained products. She returned to the OR on the fifth PP day for another D&C.How should I report both D&Cs?

California Subscriber

Answer: You should use 59812 (Treatment of incomplete abortion, any trimester, completed surgically) for the first procedure and 59812 with a modifier 76 (Repeat procedure by same physician) for the second D&C.

Note: You should not use modifier 78 (Unplanned return to the operating/procedure room by the same physician following initial procedure for a related procedure during the postoperative period) because the repeat D&C is not related; it is identical to the first. Use of the modifier 76 lets the payer know that you are not submitting a duplicate claim.

Diagnostically, per ICD-9 rules, even if you think you got it all the last time, you should still consider the second procedure an incomplete abortion. In other words, you would still use an incomplete spontaneous abortion code, 634.11 (Spontaneous abortion; complicated by delayed or excessive hemorrhage; incomplete).