19wk IUFD with D&C

bkegler

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I need help with this case, please!

Patient was admitted to the hospital after being seen for what she thought was urinary incontinence. Turns out the patient was 19 wks 3 days pregnant and her water broke. No prenatal care. Upon admission to the hospital there was a normal fetal heart beat. After discussion the providers attempted to induce her with IV and suppositories. After 3 days of this she only progressed to 1 cm. During these 3 days, the patient did not want the nursing staff or providers to check for a heart beat. On day 3 after getting approval from the ethics commitee it was decided that it was ok to proceed with a dilation & evacuation. In the OR it was determined that there was no fetal heart beat and the procedure was carried out.

I'm having troubles determining a CPT for this but keep going back to 59856. ICD-9 wise, I know I have to use codes for a failed induction, failure of dilation, fetal demise and no prenatal care. What abortion code do I use, missed, incomplete, legally induced? Any others? Also, I know this code states that admit and visits are included, but what about an admit 3 days prior and subsequent visits in between?
 

ajs

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I need help with this case, please!

Patient was admitted to the hospital after being seen for what she thought was urinary incontinence. Turns out the patient was 19 wks 3 days pregnant and her water broke. No prenatal care. Upon admission to the hospital there was a normal fetal heart beat. After discussion the providers attempted to induce her with IV and suppositories. After 3 days of this she only progressed to 1 cm. During these 3 days, the patient did not want the nursing staff or providers to check for a heart beat. On day 3 after getting approval from the ethics commitee it was decided that it was ok to proceed with a dilation & evacuation. In the OR it was determined that there was no fetal heart beat and the procedure was carried out.

I'm having troubles determining a CPT for this but keep going back to 59856. ICD-9 wise, I know I have to use codes for a failed induction, failure of dilation, fetal demise and no prenatal care. What abortion code do I use, missed, incomplete, legally induced? Any others? Also, I know this code states that admit and visits are included, but what about an admit 3 days prior and subsequent visits in between?

Without the complete notes to review, my first impression is that the original admit was not in order to induce abortion, but to induce a delivery. There was a possibility they were going to deliver a live fetus. In that case I would bill the admit and subsequent days in the hospital for preterm labor and rupture of membranes. Since the patient did not allow evaluation of the fetus they did not know for sure that it had expired during the hospital stay.

Once the decision was made to go to the OR and at that time they determined the fetus had expired, I would then bill for surgical treatment of a missed abortion either 59812 or 59821, since the fetus was less than 20weeks.
 
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