Termination of pregnancy, Inpatient, by KCI injection and Delivery.

natashalage

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Walnut Creek, CA
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Hello Coding Community!:) I will greatly appreciate your expertise in the following case since I am still learning and struggling between 2 coding options.

12/12- pt was admitted for complication of pregnancy, 25 weeks.

12/13-The decision was made to terminate the pregnancy with fetal intracardiac KCI injection . After the procedure, confirmed intrauterine fetal demise.

12/14- Induction of labor began with misoprostol and she delivered a stillbirth baby.

There are 2 options how to code it (I think):

Option 1: 59850-Induced abortion, by 1 or more intra-amniotic injections (amniocentesis-injections), including hospital admission and visits, delivery of fetus and secundines;

Option 2: 59897-unlisted fetal invasive procedure like 59866-multiple pregnancy reduction AND 59409-delivery (since 25w)

After reviewing what KCI and intra-amniotic injections are, I made a conclusion that 59850 is not the right code because KCI is potassium chloride injected into heart of the fetus. While 59850 is a hypertonic solution via drip via amniocentesis. KCI is used in 59866- multiple preg reduction; however, it's for Reduction leaving one viable fetus alive. In our case the main objective was to completely terminate the pregnancy. I am thinking to code is as unlisted 59897 with like code 59866-reduction and then the Delivery= Option 2.
I will greatly appreciate you help! Thank you.
 
Last edited:

nielynco

Networker
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Guadalupita, NM
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Hello Coding Community!:) I will greatly appreciate your expertise in the following case since I am still learning and struggling between 2 coding options.

12/12- pt was admitted for complication of pregnancy, 25 weeks.

12/13-The decision was made to terminate the pregnancy with fetal intracardiac KCI injection . After the procedure, confirmed intrauterine fetal demise.

12/14- Induction of labor began with misoprostol and she delivered a stillbirth baby.

There are 2 options how to code it (I think):

Option 1: 59850-Induced abortion, by 1 or more intra-amniotic injections (amniocentesis-injections), including hospital admission and visits, delivery of fetus and secundines;

Option 2: 59897-unlisted fetal invasive procedure like 59866-multiple pregnancy reduction AND 59409-delivery (since 25w)

After reviewing what KCI and intra-amniotic injections are, I made a conclusion that 59850 is not the right code because KCI is potassium chloride injected into heart of the fetus. While 59850 is a hypertonic solution via drip via amniocentesis. KCI is used in 59866- multiple preg reduction; however, it's for Reduction leaving one viable fetus alive. In our case the main objective was to completely terminate the pregnancy. I am thinking to code is as unlisted 59897 with like code 59866-reduction and then the Delivery= Option 2.
I will greatly appreciate you help! Thank you.
Your thinking is sound on this one. You should bill the delivery code, but 59409 may not be the correct code is your provider has been the one caring for the patient for her full pregnancy and will be taking care of her following the termination. In that case look at the 59410-52 code (for reduced services) which takes care of any prenatal, induction and post delivery care in both the hospital and outpatient. But of note, 59409 would also include the induction method used. The fetal intracardiac injection can only be reported using 59897 and I would compare the work to 59866. You might be able to make the case for billing the initial hospital care as the admission was for a complication of pregnancy, not initially for delivery.
 

nielynco

Networker
Messages
27
Location
Guadalupita, NM
Best answers
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Your thinking is sound on this one. You should bill the delivery code, but 59409 may not be the correct code is your provider has been the one caring for the patient for her full pregnancy and will be taking care of her following the termination. In that case look at the 59410-52 code (for reduced services) which takes care of any prenatal, induction and post delivery care in both the hospital and outpatient. But of note, 59409 would also include the induction method used. The fetal intracardiac injection can only be reported using 59897 and I would compare the work to 59866. You might be able to make the case for billing the initial hospital care as the admission was for a complication of pregnancy, not initially for delivery.
Correct, I meant 59400-52, not 59410-52 if you provided all of her care.
 
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