# Suction D&C Blighted Ovum



## Bamatide

Can someone clarify which procedure code is correct when performing a Suction D&C of a blighted ovum? I was leaning towards 59841 ( Induced abortion by dialation and evacuation).


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## preserene

59840 is the most appropriate code . The reason is: it is an induced (abortion ) procedure by Dilation and Curettage where in curettage is mandatory. Every Blighted Ovum treatment with suction and dilation will not be complete unless curettage is done. So after dilation and suction suction, it is completed by cerettage for sure. 

This code fits for Corneous mole, and for induced abortion otherwise not classified elsewhere also.
The code  59841 holds good for induced abortion with dilation and evacuation only. 
Thank you.


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## AL

We just had this question on a mock CPC exam. "Patient underwent evacuation of uterus for blighted ovum, was in her second month. The answer was 631 and 59820." Coder's desk reference says 59820 treats a missed abortion by suction curettage. 59840 says physician terminates a pregnancy.


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## preserene

The possiblities  I had been analysing were: 59820,59821 59840, 59841.
59820 and 59840 are the filtered ones.
59820- is for those missed abortions which were COMPLETED surgically. The word "completed" gives us an information that there was incompletness of missed abortion process before in hand( be it spontaneous or induced by any one medically or otherwise but completed surgically). The incompleteness and the vague procedure info about exact surgical procedure in the code 59820 are the criteria which leads me to the other option- 59840-- which clearly  STATES  that it was induced abortion by DILATION AND CURETTAGE.
atients rarely goes for incompleteness of its own  with Missed abortion/ or once the diagnosis made as missed abortion the doctors do not wait (medical necessity) for it to happen of its own /for incompleteness.

So in this scenario, if the os was closed (usually it is the state of affair) at the time of procedure or diagnosis/ or if the doctor documented it was induced/OS CLOSED then this 59840 holds  good and appropriate/or not stated that it was open or incomplete, this is the code I would assign.

Moreover in one of the coding question from AAPC, the answer to Missed abortion with procedure D & C - was 59840, just as I mentioned earlier.

Well, could you please post the procedural notes so that we can come up with the correct assignment for sure?


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## Bamatide

Here is the description of the procedure in detail:

Preoperative DX : Blighted Ovum

A single tooth tenaculum was placed on the anterior lip of the cervixand for paracervical block Xylocaine was placed at 2, 4,8,10 o'clock positions. At this time Sequential Pratt dialtors were utilized to allow a #9 curved suction curette to be passed. The curette was passed until the uterine fundus was gently noted. At this time the suction curette was rotated at the top of the fundus to remove all products of conception. This was done 3 times to ensure all products have been removed form uterus. The final pass was done doing a gentle suction curettage of the uterus to note gritty texture. The suction curette was removed as well as tenaculum.


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## preserene

No mention of bleeding .Dilation was done up to 9size dilator at least for the curette to get inside. It goes to say that the cervical os was closed / needed dilation to introduce the curette. It was an INDUCED ABORTION ( mandatorily)
Curetting was done by sharp curette or suction curette , it was CURETTAGE.
So, the procedure was Induced Abortion with D& C, essentially to bring the products out and to be sure there was complete evacuation. The suction was a component of the D& C here. It does not have to be reported separately or high lighted here; mostly, blighted ovum induction D& C needs suction to ensure completion.
I would suggest strongly still for *59840*.
 Thank you.


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## MJ4ever

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


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