Wiki 59821 vs 59510 19.4 weeks gestation, placental abruption

Rozette

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I need help please. One of our patients went to the ER complaining of pelvic pain. Her water broke, while standing in the ER. Our doctor was called in and the patient was sent to labor and delivery with heavy bleeding and pain. Provider performed c-section. She is our patient and if she was 20 weeks, I believe we could use 59510. However, she was only 19.4 weeks gestation. Are we to use 59821, treatment of missed abortion?
 
I need help please. One of our patients went to the ER complaining of pelvic pain. Her water broke, while standing in the ER. Our doctor was called in and the patient was sent to labor and delivery with heavy bleeding and pain. Provider performed c-section. She is our patient and if she was 20 weeks, I believe we could use 59510. However, she was only 19.4 weeks gestation. Are we to use 59821, treatment of missed abortion?
No. The code 59821 implies a vaginal procedure, not cesarean approach. And it also means the baby was pronounced dead prior to the cesarean so you would be reporting O02.1 as your diagnosis (but not a Z3A code as this represents an abortive outcome and is not also reported per ICD guidelines). In this case I would bill a cesarean using 59510, but with a modifier -52 as you are providing very reduced global services. But be sure you documentation clearly indicates why this mode of delivery the combination of early fetal demise and cesarean may raise questions with the payer.
 
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