Wiki IUFD, delivery at 19 Weeks

Hello,
I was hoping to get some clarification on billing delivery, fetal demise, 19 weeks. Research shows bill E/M + 59414 when documented. Our patient was admitted, given Miso vaginally twice for induction. Our doctor did H&P for admittance (6/16 18:27), miso per vagina. Then he checked in about 4 hours later and gave her Miso per vagina again (6/16 22:21). Then she delivered about four hours later (6/17 02:43), he noted placenta delivery also. Then he checked in about 6 hours later (6/17 9:12). And finally D/C about three hours later (6/17 11:45). Wouldn't I charge for H&P, 99223, daily hospital visits 99231, twice, the delivery E/M with placenta 59414, Inpatient care d/c 99238? (The delivery E/M- is that based on how long she was pushing for.. There's a lot more to this delivery than E/M.. Thank you for your help. Desiree

What do you think about CPT 59855? I don't like that it says induced abortion, but otherwise it sounds more accurate then E/M..
It states "Induced abortion, by 1 or more vaginal suppositories, with or without cervical dilation, including hospital admission and visits, delivery of fetus and secundines.

I am not an expert, still learning but I agree with 59855 based on key words " induced abortion with Vaginal suppositories." When i see ' vaginal suppositories', i immediately recall this code. As for, E/M, i Think i would code E/Ms because 59855 is not a global package like 59400 deliveries.

desireewhite185@yahoo.com said:

What do you think about CPT 59855? I don't like that it says induced abortion, but otherwise it sounds more accurate then E/M..
It states "Induced abortion, by 1 or more vaginal suppositories, with or without cervical dilation, including hospital admission and visits, delivery of fetus and secundines.

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natashalage said:

I am not an expert, still learning but I agree with 59855 based on key words " induced abortion with Vaginal suppositories." When i see ' vaginal suppositories', i immediately recall this code. As for, E/M, i Think i would code E/Ms because 59855 is not a global package like 59400 deliveries.

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59855 is for a termination so would not be applicable in this case as it is a fetal demise. You can code the admit on 6.16 plus 59200 for the vaginal meds; on 6.17 you could charge the placenta delivery depending on documentation or D+C depending on documentation plus the discharge

Thank you very much for your rational! So 'fetal demise' is the key word. then you determine how the fetus was delivered: medically or surgically (have CPT codes based on trimester). Then we look at the weeks of gestation: if 20 w += could be a delivery CPT, if not- potential E/M. From this case above, I learned that we can code for the placenta (medical induction at 19 weeks.) I didn't know that 59855 is only for termination of the live fetus; I thought it could be used for live and demised- now I know and will make a note of it. There are so many rules and I want to say Thank you for your answer with rational.

Hello again, I was adding some notes to my abortion file and came up with the scenario for which I will greatly appreciate your advice. Thank you!
What if the same pt at 19w comes for extraction of the demised fetus via Vaginal suppositories AFTER KCL (forgot the name) injection into the live fetus was done the day before? The Termination of pregnancy was done by KCL first, then Vaginal sup. (PV) and now pt is delivering at 19 weeks. May I code 59855?

natashalage said:

Hello again, I was adding some notes to my abortion file and came up with the scenario for which I will greatly appreciate your advice. Thank you!
What if the same pt at 19w comes for extraction of the demised fetus via Vaginal suppositories AFTER KCL (forgot the name) injection into the live fetus was done the day before? The Termination of pregnancy was done by KCL first, then Vaginal sup. (PV) and now pt is delivering at 19 weeks. May I code 59855?

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Hi, no because the fetus is no longer living. For intra-amniotic injections with subsequent delivery you could use 59850 but I am not sure if this would include KCL as it seems to be an intracardiac injection. Also an MFM would likely perform the injection, and may not do the delivery.