Wiki Need help with Incomplete Spontaneous abortion at 19 weeks in ED. Our provider delivered the placenta. Next day did removal of impacted IUD.

[tblmt1966]

Our patient at 19 weeks pregnant, known fetal demise for several days. Came into the ED by ambulance with bleeding. The ED provider delivered the fetus and clamped the cord. Our provider was enroute to ED. Upon arrive in the ED transported the patient to L&D for further care of the Placenta left insitu. Also, with known retained IUD.

The provider did H&P 1/6 in plan stated the following:
PLAN/NEW ORDERS
Incomplete AB on admission
Fetus delivered without issue or complication in ED
Placenta insitu administered 800mcg misoprostol vaginally
Given concern for infection given foul odor triple antibiotics initiated
Labs collected
Ultrasound ordered
Continue active management for placenta delivery.
Continue to monitor for change in condition.

The placenta was delivered on 1/6/ vaginally. Our same provider the next day did laparoscopic removal of IUD that was found to be Perforated IUD.
Then on next 1/8 another provider within our practice did hospital discharge.

My question I need to bill E/M Admission for 1/6. If would I need add modifier 25. The provider did not document in the HPI the decision to do Lap. removal of the IUD. Also, would I code the discharge as well?

Thank you in advance on help with case.
Trish

 

[natashalage]

hello,
I am not an expert and still learning. We have coding experts that monitor this forum luckily for us and they will respond to you. My thinking is: you can bill E/M and delivery of placenta (this week or last week this topic was discussed here and i learned that if MD delivered the placenta, you can bill for it along with E/M- see that post-very helpful)
I would also bill for Lap removal IUD which will be Unlisted CPT more likely compared with 49402 ( you can also find this post in this outstanding forum)

 

[TThivierge]

Hello Tblmt1966,
Here is info I would assign CPT and diagnosis codes in your OB GYN scenario. See ICD10 codes of 003 blocks and block Z3A per trimester dates. CPT codes of CPT 58301 remove IUD, CPT 59820 Spontaneous AB, ultrasound CPT 76948, and CPT 59414 removed placenta.
I hope this data helps you .
Lady T

 

[tblmt1966]

Hello Tblmt1966,
Here is info I would assign CPT and diagnosis codes in your OB GYN scenario. See ICD10 codes of 003 blocks and block Z3A per trimester dates. CPT codes of CPT 58301 remove IUD, CPT 59820 Spontaneous AB, ultrasound CPT 76948, and CPT 59414 removed placenta.
I hope this data helps you .

I'm confused with your answer. For the charges that I need to bill for are for inpatient provider services so coding for ultrasound would not be correct. The hospital owns the equipment, and our provider did not read the ultrasound. Coding rules indicate that an abortion after 20 weeks 0 days is report using delivery codes, which 59414 is part of the delivery codes. The E/R provider delivered the fetus that was demised. My provider only did the admission on 01/6/2023. The placenta was delivered on 1/6/2023 from the administration of below medication.
Placenta insitu administered 800mcg misoprostol vaginally.
Given concern for infection given foul odor triple antibiotics initiated.
Labs collected.
Ultrasound ordered.
Continue active management for placenta delivery.
Continue to monitor for change in condition.

With our patent only being 19 weeks' gestation I have to bill E/M visit for that date. Was their change in the coding rules regarding this that I am not aware of? If so documentation to support billing for 59414.

Thank you

Trish

 

[TThivierge]

Hi Trish..you are correct....see info below from Codify Aug 13 2018
Complete” or “incomplete” may decide your CPT® coding options.
If you have a claim for abortion on your desk, you may be wondering how to navigate abortion diagnoses, and you should allow your physician’s documentation be your guide.
Generally, you will designate nonelective abortions at fewer than 22 weeks gestation as spontaneous incomplete (O03.0-O03.2, O03.3-, O03.4), spontaneous complete (O03.5-O03.7, O03.8-, O03.9) or missed abortion (O02.1). Although technological advances enable physicians to detect pregnancy in its earliest stages, coding for nonelective abortions has become more complicated, says Melanie Witt, RN, MA, an independent coding consultant in Guadalupita, N.M. When a patient presents with no prior pregnancy diagnosis, the ob-gyn can use tools such as ultrasound and beta subunit HCG (human chorionic gonadotropin, a pregnancy test that helps determine the stage of pregnancy) to confirm pregnancy and decide how far it has progressed. When a patient presents with a nonelective abortion, diagnosis and procedural coding can be a challenge, especially if the pregnancy terminated very early on. Women frequently do not seek medical attention for a delayed menstrual cycle because they may not be aware that conception occurred. If the ob-gyn diagnoses a pregnancy and it later terminates, either spontaneously or by induction, you should report the related physician services. And the diagnosis coding can be critical to ensuring proper payment for the doctor’s work.

Patient’s Dx Will Affect Your CPT® Coding
When determining the correct CPT® code for treating a nonelective abortion, the first question you should ask is whether the ob-gyn performed surgery to complete the process.
If the patient presents with a complete spontaneous abortion, no products of conception remain in the uterus. You would likely report an E/M code (99201-99215, Office or other outpatient visit ...) because he doesn’t perform any type of procedure to treat the patient’s symptoms, coding experts say. You would link the E/M service to the appropriate O03.5-O03.9 code on the CMS-1500 form. If the patient has an incomplete spontaneous abortion, however, she would still have products of conception retained, though they may be expected to pass naturally without surgical intervention. If the products of conception do not evacuate on their own, the ob-gyn may perform a dilation and curettage (D&C). In this case, you would submit 59812 (Treatment of incomplete abortion, any trimester, completed surgically) with the incomplete spontaneous abortion diagnosis, such as O03.4 (Incomplete spontaneous abortion without complication). But if the patient has a missed abortion, products of conception always remain in the uterus. As with incomplete spontaneous abortions, the ob-gyn may have to evacuate a dead embryo or fetus from the uterus through D&C. But in the case of missed abortions, you would report 59820 (Treatment of missed abortion, completed surgically; first trimester) or 59821 (... second trimester) instead of 59812 because 59820-59821 more specifically describe the service performed. In this case, you would link the procedure code to O02.1. Note that 59820 has a 90 day global period. This means that while you may report E/M services for care prior to the discovery of the missed abortion, and the E/M the day of or day before the surgery that was related to the decision to do surgery (appending a modifier 57 (Decision for Surgery)), all subsequent E/M services related to recovery from this surgery are included for 90 days, says Jan Rasmussen, PCS, CPC, ACS-GI, ACS-OB, owner/consultant of Professional Coding Solutions in Holcombe, Wis.
Hope this data helps you
Lady T