Wiki Failed abortion with RPOC ... help needed

debellis59

Networker
Messages
68
Location
Hermiston, OR
Best answers
0
Hi All

I have a patient who had a failed medical abortion (other provider) and so she came to us with abdominal pain. We found retained products of conception ... I am at a loss on how to code this. We don't do abortions where I work, we deal only with SAB, IUFD, MAB, etc. I used 59812 for treatment of incomplete abortion ... and with POC still there that was the only CPT that fit. The diagnosis I used O07.4 Failed attempted termination of pregnancy without complication, although I didn't like it. Anyway, it was denied, not unexpectedly. There just don't seem to be any really decent diagnoses that would go with what this scenario is. We're being told to bill the State (Oregon) for the abortion but the codes are for induced abortions ... we're just dealing the POC that were not adequately removed by the other provider.

Any help you can give on coding this correctly would be very much appreciated.

Thank you. I've provided the main part of the note below

Indication for Surgery

23yr old G3P2012 s/p medical abortion with ongoing pain and concern for retained products of conception who presented for DandC.

Preoperative Diagnosis

Failed medical abortion

Pelvic pain

Postoperative Diagnosis

Same

Operation

Suction dilation and curettage

Surgeon(s)

Removed surgeon's name

Assistant(s)

none

Anesthesia

General_2

removed name (Anesthesiologist)

removed name (Anesthesia Care Provider)

Estimated Blood Loss

50ml

Urine Output

0ml

Findings

1. 8wk anteverted uterus

2. Possible retained products of conception vs organized clot

Infection Present at Time of Surgery

None

Specimen(s)

Specimen ID: A. Products of conception [1]

Specimen Type: Permanent [1]

Specimen Coll. Date: 02/10/2023 17:23:00 [1]

Specimen Source: Other/See comment [1]

Body Site: Site Unspec [1]

Implants

None

Complications

None

Drains

None

Technique

After informed and signed consent, the patient was taken to the operating room, where a huddle was performed with all appropriate surgical staff. General anesthetic was administered without difficulty. She was placed in high lithotomy position and prepped and draped in the usual sterile fashion. A pelvic examination revealed the findings above.



A bivalve speculum was placed into the vagina. A single tooth tenaculum was used to grasp the anterior lip of the cervix. Paracervical block was performed with 10ml of 0.5% Marcaine with epinephrine at 5 and 8 o'clock in the cervicovaginal junction. The cervix was dilated to 24 French with Pratt dilators. An 8mm rigid curved cannula was used to evacuate the uterine contents until a gritty texture was noted throughout.



The tenaculum was removed and the cervix was noted to be hemostatic. The speculum was removed concluding the procedure. All counts were correct. She was taken out of lithotomy position and awoken without difficulty. She was transferred to a gurney and taken to the recovery room awake, comfortable and stable.
 
Hi All

I have a patient who had a failed medical abortion (other provider) and so she came to us with abdominal pain. We found retained products of conception ... I am at a loss on how to code this. We don't do abortions where I work, we deal only with SAB, IUFD, MAB, etc. I used 59812 for treatment of incomplete abortion ... and with POC still there that was the only CPT that fit. The diagnosis I used O07.4 Failed attempted termination of pregnancy without complication, although I didn't like it. Anyway, it was denied, not unexpectedly. There just don't seem to be any really decent diagnoses that would go with what this scenario is. We're being told to bill the State (Oregon) for the abortion but the codes are for induced abortions ... we're just dealing the POC that were not adequately removed by the other provider.

Any help you can give on coding this correctly would be very much appreciated.

Thank you. I've provided the main part of the note below

Indication for Surgery

23yr old G3P2012 s/p medical abortion with ongoing pain and concern for retained products of conception who presented for DandC.

Preoperative Diagnosis

Failed medical abortion

Pelvic pain

Postoperative Diagnosis

Same

Operation

Suction dilation and curettage

Surgeon(s)

Removed surgeon's name

Assistant(s)

none

Anesthesia

General_2

removed name (Anesthesiologist)

removed name (Anesthesia Care Provider)

Estimated Blood Loss

50ml

Urine Output

0ml

Findings

1. 8wk anteverted uterus

2. Possible retained products of conception vs organized clot

Infection Present at Time of Surgery

None

Specimen(s)

Specimen ID: A. Products of conception [1]

Specimen Type: Permanent [1]

Specimen Coll. Date: 02/10/2023 17:23:00 [1]

Specimen Source: Other/See comment [1]

Body Site: Site Unspec [1]

Implants

None

Complications

None

Drains

None

Technique

After informed and signed consent, the patient was taken to the operating room, where a huddle was performed with all appropriate surgical staff. General anesthetic was administered without difficulty. She was placed in high lithotomy position and prepped and draped in the usual sterile fashion. A pelvic examination revealed the findings above.



A bivalve speculum was placed into the vagina. A single tooth tenaculum was used to grasp the anterior lip of the cervix. Paracervical block was performed with 10ml of 0.5% Marcaine with epinephrine at 5 and 8 o'clock in the cervicovaginal junction. The cervix was dilated to 24 French with Pratt dilators. An 8mm rigid curved cannula was used to evacuate the uterine contents until a gritty texture was noted throughout.



The tenaculum was removed and the cervix was noted to be hemostatic. The speculum was removed concluding the procedure. All counts were correct. She was taken out of lithotomy position and awoken without difficulty. She was transferred to a gurney and taken to the recovery room awake, comfortable and stable.
From a purely coding standpoint, you have billed this correctly but policy is getting in way. I probably would have used O07.39 as this was a failed abortion with a complication (retained products of conception), but 59812 is correct for this procedure. All you can do now is appeal giving them the path report to show that it was products of conception and the provider should provide a complete history for this patient as well to the payer (going directly to the medical director of the plan or requesting review of the documentation by a board certified OB/GYN will also help here.
 
From a purely coding standpoint, you have billed this correctly but policy is getting in way. I probably would have used O07.39 as this was a failed abortion with a complication (retained products of conception), but 59812 is correct for this procedure. All you can do now is appeal giving them the path report to show that it was products of conception and the provider should provide a complete history for this patient as well to the payer (going directly to the medical director of the plan or requesting review of the documentation by a board certified OB/GYN will also help here.
Thank you very much. I will consider the O07.39 in the future. I will request the biller submit chart notes for reconsideration and to request a board certified OBGYN.
 
Top