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D&E Molar pregnancy- 2nd procedure

  1. Default D&E Molar pregnancy- 2nd procedure
    Clearnace Sale
    We have a patient who had a D&E for Molar pregnancy 3/17/10. Path came back positive for Molar pregnancy.

    Patient presents to OB/GYN office 03/31 complaining of increased vaginal bleeding, cramping.

    US was done. Found some fluid collection and some irregular appearing solid components.

    Patient was scheduled for 2nd D&E done same day 3/31. with indication molar pregnancy- retained products of conception.

    Path came back from this procedure no evidence of Molar pregnancy/ no evidence of Product of conception.

    How do we bill this 2nd D&E? Use the same D&E for Molar pregnancy code as billed 3/17?

    And what DX do we use? Indication was Molar pregnancy and POC, but not founded by pathology.
    Rachell Lindley, CPC
    Multispecialty Clinic Coding
    Internal Medicine
    General Surgery
    Family Medicine

  2. Default tressamm
    Hi -- Did you ever get a responce to your molar pregnancy question? If so, I was hoping you could tell me

  3. #3
    Hi Rachell,
    What was the physician's pre- and post- op diagnosis?

    I would consider those dx and the findings from the U/S. I'm assuming the fluid collection and solid component found on the U/S were the reason for the D&E.

    Querue the physician to be sure why it was done : )

    Hope this helps,

    We had an intereting today, where a D&C was done for a pre-op dx of missed abortion, post-op dx of missed abortion vs ectopic pregnancy and the labs were not showing any products of conception from the D&C. It ended up being an extrauterine pregnancy per consulting the physician.
    Fun fun.
    The Oracle

  4. Default
    Molar pregnancy /hydatidiform mole has the great potential to turn out to be choriocarcinoma- of its any stage. It is in the group of Trophoblastic Diseases. Immediate curettage, as she presents bleedings after D&C or frequent follow up with Quatitative HCG titers, are all mandatory for molar pregnancy/ vesicular mole. It is also called as check curettage to obtain the tissue( for histopathology) for trophoblastic nature and rule out malignant transformation. There need not be any molar tissues /remnants of molar pregnancy for this to happen.
    Diagnosis code as the physician documents –like, trophoblastic disease, post molar, molar etc- all meets the common factor-of the code 630.
    It can be placed under gynecological D&C- 58120 could even merit well in this scenario.- gynec D& C.

  5. Default
    Barbara, negative D& C ( for products of conception), is all the more positive clue for ectopic pregnancy to be there.
    They both mimic/share the same picture very often( in early pregnancy) to make the diagnosis hard.

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