# D&E Molar pregnancy- 2nd procedure



## rachell1976 (Apr 5, 2010)

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.


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## tressamm (Apr 26, 2011)

*tressamm*

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


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## MJ4ever (Apr 26, 2011)

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.


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## preserene (Apr 26, 2011)

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.


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## preserene (Apr 26, 2011)

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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