Wiki OB Billing

[PamWright]

I'm trying to understand the difference between billing abortion and regular vaginal delivery. I have listed the cpt codes below with example of op report.

1. Patient was 25 weeks pregnant and was induced delivered stillborn. What cpt code should I use? I billed 59400
2. Patient spontaneous delivery of a non viable fetus. Small pieces of placenta were found? What cpt code should I use? I billed 59812
3. Patient spontaneous delivery of a non viable fetus. Placenta was intact. What cpt code should I use? I billed 59820

59400- We induced patient to deliver non-viable fetus.
59812- Patient spontaneous aborted with small pieces of placenta remaining. (DC)
59820- Patient spontaneous aborted and we surgically have to remove fetus.

 

[meghanhannus]

I'm trying to understand the difference between billing abortion and regular vaginal delivery. I have listed the cpt codes below with example of op report.

1. Patient was 25 weeks pregnant and was induced delivered stillborn. What cpt code should I use? I billed 59400
2. Patient spontaneous delivery of a non viable fetus. Small pieces of placenta were found? What cpt code should I use? I billed 59812
3. Patient spontaneous delivery of a non viable fetus. Placenta was intact. What cpt code should I use? I billed 59820

59400- We induced patient to deliver non-viable fetus.
59812- Patient spontaneous aborted with small pieces of placenta remaining. (DC)
59820- Patient spontaneous aborted and we surgically have to remove fetus.

Hello Pam C,

Patient 1: Since the patient was 25 weeks gestation I am thinking it would be coded as CPT 59409 modifier 52 and also billing out for the antepartum care depending on the number of prenatal visits? I recommend checking with the patient's insurance carrier policy to see how they prefer this situation to be coded/billed. I have also seen it coded as global CPT 59400 Mod 52 but the patient had to have a certain number of prenatal visits in order to bill the global code.

Patient 2: With the information provided I am assuming that this patient had retained placenta after the spontaneous abortion? You would bill CPT 58120 since the abortion was complete. CPT 59812 is billed when retained products of contraception remain after an incomplete abortion.

Patient 3: It does not sound like this patient spontaneously aborted as I am assuming the fetus was still within the uterus hence the removal? This is called a missed abortion and if the fetus was less than 13 weeks gestation (first trimester)than CPT 59820 is the correct code to bill. If the fetus was 14-27 weeks (second trimester) CPT 59821 is the correct code to bill.