# 59812 VS Delivery code



## armymomryan

Dr. induced labor and had a spontaneous vaginal delivery, delivering a stillborn at 20 wks and 1 day, is this coded as a vaginal delivery or coded as miscarriage (59812)?

Any help appreciated.


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## brownm

I usually code it as vaginal delivery with diagnosis 632.


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## tjlock

You can only code a delivery if the pt is more than 22 weeks along. You would not use a delivery code for a 20 week gestation. 59812 with 632 would be the correct coding.


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## JLM322

The description of CPT code 59812 states that the "physician performs a dilation and suction currettage." You cannot use 59812 if this did not happen. 59812 is for surgical treatment of an abortion. 59820 and 59821 are still surgical procedures.

I come across this situation often. What code do you use when the patient delivers a fetal demise through the vagina without surgery? The Maternity Care and Delivery codes from 59400-59622 do not specify the gestational age so why can't we use these codes? Insurance companies have paid for delivery codes when I used ICD-9 code 632 without question. 

I suppose 59855 would make the most sense with fetal demises; however you have the problem with insurance companies deniying this CPT code thinking the procedure is an elective abortion so you may have to submit an appeal. Also Illinois Medicaid considers this procedure an abortion and will not pay. They will pay CPT code 59409.

I am interested in any thoughts regarding this issue and what your experience has been with fetal demise deliveries.

Joanna


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## preserene

Your case merits into the Abortion and it does not go into the entry of IUFD / fetal Death.

Generally, by and large, from the date of LMP to the date of expulsion, if 22weeks and more, goes into registry of  'Delivery'; if less than 22 weeks it is accounted as 'Spontaneous Abortion'.

*A late death fetal death ( IUFD)  ICD- 9-CM code 656.4 - is defined in the ICD-9 tabular list as having more than 22 completed weeks of gestation , while SPONTANEOUS ABORTION appears with a separate code 634.xx presumably for earlier fetal deaths occurring prior to 22weeks. *.
The importance to know whether it  goes into the registry of abortion or into the fetal deaths are the main stay of the originally intended Classification and its necessity on death entry registry point of view. State fetal death certificate reporting had been the primary source for determining the risk of still birth, or late fetal death.
A cohort of 6254 pregnancies surviving at least 20weeks of gestation was identified through pregnancy testing and follow up at Califorina. In the prospective studies, gestational age at outcome is based on time between LMP and expulsion, not on birth weight equivalencies.
When the legal definition of reportable fetal death has varied from time to time and state, reasonable consistent trends in fetal death ratios ( the number of fetal deaths per1000 live births) have been observed across the country and over years.
Most states now require a fetal death over 20weeks of gestation. Some specify fetal delivery weight 350-500 gms as an alternative reporting requirements based on gestational ages less than 20weeks, OR based on fetal delivery weight have consistently higher ascertainment of fetal deaths between 20-28weeks. After 28weeks of gestation , reporting of fetal deaths appears to be fairly COMPLETE.
The chances of under reporting are more in cases like, if fetus dies in utero before 20wks of gestation but is carried for days or even weeks after wards, as in the case of missed abortion, whether or not, it should be reported may be unclear to physicians.
The same medical personnel responsible for reporting fetal deaths often use the International Classification od diseases(ICD) index, to code hospital discharge summaries. A late death fetal death (ICD-( code 656.4) is defined in the ICD-9 tabular list as having more thn 22 completed weeks of gestation , while spontaneous abortion appears with a separate code( 634) presumably for earlier fetal deaths occurring prior to 22weeks. 
Reporting practices found in the Kaiser program may be representative of reporting practices elsewhere.
Perhaps Physicians may rely more on their obstetric practices and training than on state regulations to determine reportability..
*Williams Obstetrics , a renounced Book for Obstetrics in our country, emphasizes birthwieght ‘as the main criterion for reportability, stating’ .. fetuses weighing less than 500 grams,  usually are not considered as births, but rather as ABORTIONS, for purposes reportability.*Of perinatal statistics”. Gestational age is then [/B]reffred to in terms of equivalency to birthweight. It is being practiced at some major organizations to offer a woman options for disposition of the body of the fetus if it weighs over 500 grms. Such options are not routinely offered for smaller fetuses. .
 The general consensus /or trend as per this study, could be for fetal death reportablity purposes:- 'fetuses under 500 gms may seldomly get reported regardless of time since LMP.


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## Mojo

I agree with Melissa. IUFD after 20 weeks gestation with induction and vaginal delivery is billed with a delivery code.

Per ACOG:
http://www.acog.org/from_home/departments/coding/terminations-abortions.pdf


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## preserene

Thank you Majo.
For coding purposes, I feel that, with the view of our code Books available guidelines and  with the view of some payers /some states, some institutions or practices are  still with the gestational 22weeks0 as a cut off, we code as per the Physicians of the Practice documentation cut off line between Missed Abortion. THE RULE NO.1 . It is always good to be abreast with our doctor’s policy and the Institutional policy for coding.
With the reference you gave and as per the latest practice guidelines (ACOG), 20weeks 0 is also widely accepted norm in Many states as still birth /fetal death delivery.
This I am aware of from the Practice bulletin in OBGYN clinical management guidelines- March 2009.
(But the Meta-study I quoted was way back a few years ago from California.)
The united States National center for Health Statistics, defines FETAL DEATH as the delivery of a fetus showing no signs of life as indicated by the absence of breathing, heart beats, pulsation of the umbilical cord, or definite movements of voluntary muscles. Though there is not complete uniformity among states with regard to birth weight and gestational age criteria for reporting fetal  deaths. However the suggested requirement is to report fetal deaths at 20weeks or greater of gestation(if the gestational age is known, or a weight greater than or equal to 350 grams if the gestational age is not known.
The cut off of 350grams is the 50th percentile for weight at 20weeks of gestation.
As such, the payers are flexible with 20 weeks and 22weeks as cut off. Good for us as coders.
The only thing is the statistics of fetal death, and eventually, the Perinatal Mortality Rate would go up , which not in our scope. Right!!? But it is our National Interest and the international classification code nomenclature guidelines of death entry report.
I would also welcome any one posting the ‘ strict cut off point at 20weeks’ from our coding manuals.
Thank you.


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