Wiki Abortion Question w/injection

camarges

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I have 2 patients with similar issues. Both PTs were 24+/- weeks pregnancy, they each had an injection to induce fetal demise, both were outpatient and the actual abortion took place a day or so later. In each case the provider billed 59850 (an inpatient only code) with 76998 for the ultrasound. My question is since the PTs were outpatient and the abortion was not done on the same day as the injection - what CPT code should be billed instead of 59850? I was thinking 59000 (amniocentesis) because of the injections with 76946 for the ultrasound?? Here are the descriptions of the 2 patients on the first day.

PT 1 - 24 wks - Procedure Note:
Ultrasound was performed to confirm fetal presentation and the abdomen was marked. 5cc of local was infiltrated subcutaneously. The abdomen was cleansed with betadine x2. Under ultrasound guidance, a spinal needle was used to inject 10cc of KCl (20 mEq) intracardiac. A repeat ultrasound 15 minutes later conformed cessation of fetal cardiac activity.

PT 2 - 23.6 wks - Procedure Note:
Ultrasound was performed to confirm fetal presentation, noted to be in breech presentation, and the abdomen was marked. The abdomen was cleansed with betadine x2. Under ultrasound guidance, a spinal needle was used to inject 1.5mg of digoxin intrafetal.
 
I did a bit of searching and couldn't find anything. I think unfortunately you have to use an unlisted code as we are not supposed to "..select a CPT code that merely approximates the service provided. If no such procedure or service exists, then report the service using the appropriate unlisted procedure or service code.” I can think of one instance where we had to create an unlisted for a similar reason for some kind of excision of vaginal mesh - done in office instead of in hospital where that was specified in code.
 
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