Wiki Coding Induced Abortion at 18 weeks withmisoprostol

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peabodym

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A patient was admitted into the hospital for induced abortion at 18 weeks due to fetus demised. The patient received 600 mg orally of misoprostol and delivered vaginally in the OR on the same day. The placental was also delivered vaginally. Since the induced abortion was performed medically with oral misoprostol at 18 weeks, how is the delivery coded? Is the delivery of fetus coded with an E/M code or a delivery code?
 
When the fetus is under 20 wks, we cannot use a delivery code, so you will use E&M only. Also it's easy to get confused using the term "induced abortion" because there are cpt codes for induced abortions but those are for terminations due to health of mother or fetus, etc.
 
Hmm.. I am a new coder to OBGYN and I had a similar case. I asked ACOG how it should be coded and they replied E/M + 59414 placenta. Do you think the answer is based on the Reason for induced delivery (IOL)? Please let me know if my conclusions (from response above and ACOG) are correct?
----If IOL is for fetal demise (less than 20w) via oral misoprostol, then we code E/M.
----If IOL is for Fetal abnormalities, mother's health (less than 20w) via oral miso, then we code E/M + 59414?
Here is my correspondence with ACOG:
"On Tue, 23 Mar at 12:05 AM , Natasha Lage <natasha.lage@ wrote:

"Hello, could you please help me understand/pick the right CPT for Induced termination of pregnancy at 19 weeks for fetal multiple problems. Pt was given buccal misoprostol prior. Pt delivered stillborn fetus. I know if 20w or more, that will be a Delivery CPT.
My dilemma is that CPT 59855 is for Vaginal suppositories (prostaglandin) but my patient received it orally. Will it qualify for 59855? Sometimes I see notes when MD does not specify the route of Misoprostol/Misopresol; do I need to query the MD?
Thank you very much for your assistance. I am looking forward to hearing from you. :)
From: American College of Obstetricians and Gynecologists <answer@acogcoding.freshdesk.com>
Sent: Wednesday, March 24, 2021 1:39 PM
To: Lage, Natasha <Natasha.Lage@
Subject: Re: Response Received - [Ticket #547] Induced Termination by Misopostol -Delivery at 19weeks

Dear Natasha Lage,

This email is in response to your coding question: Induced Termination by Misopostol -Delivery at 19weeks.
You are correct that if the patient delivers on or after 20 weeks 0 days, a delivery service would be reported. Unfortunately, there is no code available to explicitly describe this particular circumstance. Therefore, it would be reported as follows:
  • E/M services (office/outpatient or observation/inpatient), along with prolonged services codes, if appropriate
  • 59414 Delivery of placenta
  • Appropriate E/M service codes for any follow up services

59855 can only be used when the procedure is initiated vaginally. If the route of administration is unclear, it will be necessary to query the physician.

It will be necessary to add a 25 modifier to any E/M service provided on the same day that the placenta is delivered.

Please let us know if we can be of further assistance.

Ticket URL: https://acogcoding.freshdesk.com/helpdesk/tickets/547

Sincerely,
ACOG Health Economics & Practice Management Team""
I will greatly appreciate all of your responses! :) Thank you.
 
Hi Natasha, that's interesting. I know that some drs do try to bill it. Based on the descriptions of 59414 in both Codify and the OB GYN Coding Companion - this is for manual removal of a placenta. So if the placenta is spontaneously delivered and the provider is just there, I personally would not code it, although I know other coders who do.
 
natashalage said:
Hmm.. I am a new coder to OBGYN and I had a similar case. I asked ACOG how it should be coded and they replied E/M + 59414 placenta. Do you think the answer is based on the Reason for induced delivery (IOL)? Please let me know if my conclusions (from response above and ACOG) are correct?
----If IOL is for fetal demise (less than 20w) via oral misoprostol, then we code E/M.
----If IOL is for Fetal abnormalities, mother's health (less than 20w) via oral miso, then we code E/M + 59414?
Here is my correspondence with ACOG:
"On Tue, 23 Mar at 12:05 AM , Natasha Lage <natasha.lage@ wrote:

"Hello, could you please help me understand/pick the right CPT for Induced termination of pregnancy at 19 weeks for fetal multiple problems. Pt was given buccal misoprostol prior. Pt delivered stillborn fetus. I know if 20w or more, that will be a Delivery CPT.
My dilemma is that CPT 59855 is for Vaginal suppositories (prostaglandin) but my patient received it orally. Will it qualify for 59855? Sometimes I see notes when MD does not specify the route of Misoprostol/Misopresol; do I need to query the MD?
Thank you very much for your assistance. I am looking forward to hearing from you. :)
From: American College of Obstetricians and Gynecologists <answer@acogcoding.freshdesk.com>
Sent: Wednesday, March 24, 2021 1:39 PM
To: Lage, Natasha <Natasha.Lage@
Subject: Re: Response Received - [Ticket #547] Induced Termination by Misopostol -Delivery at 19weeks

Dear Natasha Lage,

This email is in response to your coding question: Induced Termination by Misopostol -Delivery at 19weeks.
You are correct that if the patient delivers on or after 20 weeks 0 days, a delivery service would be reported. Unfortunately, there is no code available to explicitly describe this particular circumstance. Therefore, it would be reported as follows:
  • E/M services (office/outpatient or observation/inpatient), along with prolonged services codes, if appropriate
  • 59414 Delivery of placenta
  • Appropriate E/M service codes for any follow up services

59855 can only be used when the procedure is initiated vaginally. If the route of administration is unclear, it will be necessary to query the physician.

It will be necessary to add a 25 modifier to any E/M service provided on the same day that the placenta is delivered.

Please let us know if we can be of further assistance.

Ticket URL: https://acogcoding.freshdesk.com/helpdesk/tickets/547

Sincerely,
ACOG Health Economics & Practice Management Team""
I will greatly appreciate all of your responses! :) Thank you.
Click to expand...

Cmama12 said:
Hi Natasha, that's interesting. I know that some drs do try to bill it. Based on the descriptions of 59414 in both Codify and the OB GYN Coding Companion - this is for manual removal of a placenta. So if the placenta is spontaneously delivered and the provider is just there, I personally would not code it, although I know other coders who do.
Click to expand...
I have to disagree with ACOG on this one, especially if the placenta is not actually delivered by the provider, but delivers spontaneously, which is not clear from your original question. In fact, the person who corresponded with ACOG did not mention delivery of the placenta at all, but the responder in their department added that the delivery of the placenta could be reported. If the provider had to remove the placenta surgically, there is code for that; surgical treatment of an incomplete abortion.
 
Thank you very much Cmama12 and Nielynco! :) There is a Lot of information here to digest and learn. I know that both of you are Experts in this field. And we greatly appreciate you sharing your knowledge with many of us!
 
Anyone use HCPCS codes:
S0199 - Medically induced abortion by oral ingestion of medication including all associated services and supplies (e.g., patient counseling, office visits, confirmation of pregnancy by HCG, ultrasound to confirm duration of pregnancy, ultrasound to confirm completion of abortion) except drugs.
S0191 - Misoprostol, oral, 200 mcg

Helen
 
tintin said:
Anyone use HCPCS codes:
S0199 - Medically induced abortion by oral ingestion of medication including all associated services and supplies (e.g., patient counseling, office visits, confirmation of pregnancy by HCG, ultrasound to confirm duration of pregnancy, ultrasound to confirm completion of abortion) except drugs.
S0191 - Misoprostol, oral, 200 mcg

Helen
Click to expand...
 
These codes were developed by BCBS to address their coding concerns, but are part of the nationally available code set. There may be other payers who accept these codes, but it is always best to check with your individual payer manual before billing to prevent denials and/or payment delays.
 
I thought I would also share with everyone, for clinical information, the actual vignette that was submitted to the CPT Editorial Panel and RVU committee that describes the work involved in 59414 and was used to value the code as a "separate procedure" with its current 2.66 RVUs.

"A 31 year old G3 P2 has delivered a healthy baby vaginally. You are called for assistance by the midwife as the placenta is still in utero after 20 minutes and approximately 600cc of blood loss. The cord is avulsed.

The physician arrives in the delivery suite after being called to assist with placental delivery. Discussion with the provider is accomplished and any necessary labs and history are reviewed. Discussion with the patient and/or family is accomplished to establish the need for intervention. Consent is obtained. The physician scrubs for the procedure.

The patient is in lithotomy position after delivery. She is examined and determined to have a retained placenta. If an epidural is not in use she is given IV sedation. A manual delivery of the placenta is then attempted. The physician inserts her hand into the uterus to try to evacuate the placenta. This may take several attempts to completely remove the placenta. The patient is monitored in the delivery room to make sure that the uterus contracts.

The patient is monitored for hemostasis and serial blood counts are reviewed. The family is consulted regarding her outcome. Her bleeding is accessed. Chart work and operative note are completed."
 
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