Ob-Gyn Coding Alert

Question: Is 59855 for an elective abortion? It's hard for me to imagine that if a fetus is found to have abnormalities and will die as soon as delivered that it is inevitable not to go with this code and call it an elective abortion.

Georgia Subscriber

Answer: The term "elective" abortion means the patient makes the decision whether to abort. The CPT® codes do not make this distinction. They only indicate if the abortion happened by artificial means or the patient's body rejected the pregnancy by itself.

Code 59855 (Induced abortion, by one or more vaginal suppositories [e.g., prostaglandin] with or without cervical dilation [e.g., laminaria], including hospital admission and visits, delivery of fetus and secundines) simply means that the patient was not in labor, and for whatever reason, the ob-gyn put her into labor so she could deliver the fetus. In most cases, the fetus is of an age that it would not survive outside of the uterus. 

You can also use 59855 for a missed abortion when the baby dies in utero and the patient does not want to carry it any longer (and it was not surgically removed), or when the fetus has gross abnormalities that are incompatible with life but still has a heartbeat. Ob-gyns usually perform 59855 after the point where he can no longer perform a dilation and curettage or dilation and evacuation.