Ob-Gyn Coding Alert

Question: While in the emergency department (ED), our gynecologist saw a 17-year-old patient who had an elective abortion elsewhere. Our gynecologist had never seen this patient before. The patient came to the ED with a fever and retained products of conception (POC). Our gynecologist performed dilation and curettage (D&C), and the patient is still hospitalized for intravenous antibiotic therapy. Should I report 59812 for the D&C and 637.71 with 635.11 for the diagnoses?


Georgia Subscriber

Answer: You are correct to choose 59812 (Treatment of incomplete abortion, any trimester, completed surgically), but the linking diagnosis should be 639.1 (Complications following abortion and ectopic and molar pregnancies; delayed or excessive hemorrhage) because a physician performed a legal abortion at a different episode of care.

She is now having a complication from that abortion, so 635.11 (Legally induced abortion; complicated by delayed or excessive hemorrhage, incomplete) no longer applies to the reason for the visit. In addition, 637.71 (Unspecified abortion; with other specified complications, incomplete) no longer fits the reason for the visit because we know that the patient had a legally induced abortion.

Because the question implies that the physician has never seen the patient before, you can also report an E/M service code.

This will be either an ED visit (99281-99285) if the ED physician does not bill for it or an outpatient visit for a new patient (99201-99205) if the ED physician does bill, or an outpatient consult (99241-99245) if the ED requested a consult from your physician.

For any of these coding choices, append modifier 57 (Decision for surgery) to the E/M service to show that this was the visit during which the ob-gyn decided to perform the surgery.

You should count all subsequent care as part of the postoperative care following the surgical treatment of the incomplete abortion.