18 Week fetal demise

[cassieobgyn]

I have a couple patients who have had Cytotec induction of delivery, spontaneously vaginally at 18 weeks gestation. Patient was induced per cytotec, she delivered completely. No Suction D&C was noted to be done to allow for 59821 to be billed. I know I am also unable to bill for delivery since patient was under 20 weeks. I have tried billing code 59855 but am getting a denial due to the words "INDUCED" abortion. Any advice or ways I should code this scenario.
Thanks in advance.

 

[tracylc10]

Code 59855 is an elective code for a termination of a healthy pregnancy. In this situation, fetal demise, you would just code the appropriate E&M codes, admit, discharge and any subsequent care, per day.

 

[kathyvl74]

why is the patient being induced at 18 weeks? 59855 is also used for terminating pregnancies with chromosomal abnormalities and those that are basically unviable due to a complication. Since you did induce the delivery, 59855 may be the correct code. I'm not sure why you would think that was why it was denied. I would look at what diagnosis code you used.

 

[tracylc10]

why is the patient being induced at 18 weeks? 59855 is also used for terminating pregnancies with chromosomal abnormalities and those that are basically unviable due to a complication. Since you did induce the delivery, 59855 may be the correct code. I'm not sure why you would think that was why it was denied. I would look at what diagnosis code you used.

I agree, but it is stated that this was an "18 wk fetal demise". I am guessing that the induction was because the baby was already gone.

 

[kathyvl74]

If the patient already has a missed AB or 'fetal demise' then you would not use the induced abortion code. the abortion has already happened. I would say you bill a hospital visit for the doctor's services. It's too early to bill a delivery and the induced ab code does not apply.