We have run across a few scenarios in which a patient is diagnosed with a fetal demise between 16-20 weeks gestation. Most patients are sent to the hospital in which they induce labor utilizing cytotec and they deliver the fetus and placenta. There has been one instance where the patient was given cytotec and the doctor did a dilation and evacuation procedure.

As the fetal demise is diagnosed before 22 weeks, ICD-9 states to use 632 for the diagnosis. A chart that we have from a conference that apparently was published by ACOG at some point in time (no dates are listed), state that you can use 59855 and 59856 in this scenario. There is a question as to whether we should use 59820 instead since the dx used is for missed abortion. Does anyone have any current information as to which way these scenarios should be coded?