# Need help from the OB/GYN experts



## maine4me (Mar 26, 2012)

Would let me know how this should be coded?  Our doctor wants to use an unlisted procedure code 59897.  I am uncertain since this is a repeat of the D&E when patient originally had the miscarriage.  On exam there was a gestational sac visualized on ultrasound and patient had 10 wk uterus.  I am not sure if I should use a 59820-78 with a code for the ultrasonic guidance, or if there is a better code.  

DATE:  3/16/2012. 

PREOPERATIVE DIAGNOSIS: 
1. Missed AB. 
2. Bicornuate uterus. 
3. Possible, cornual pregnancy. 

POSTOPERATIVE DIAGNOSIS:  
1. Bicornuate uterus. 
2. Missed AB. 

PROCEDURE: Ultrasound guided D&E. 

SURGEON: Dr. Angela Boylan. 

ASSISTANT: Dr. Annette Lee. 

FINDINGS: Uterus 10 weeks size. Cervix is closed. 

ESTIMATED BLOOD LOSS: Minimal. 

SPECIMENS: Products of conception. 

DRAINS: None. 

ANESTHESIA: TIVA by Dr. Freeman. 

INDICATIONS FOR SURGERY: Patient is a 30-year-old, gravida 1, para 0, presenting with a
missed AB at 9 weeks gestation. A D&E was performed on 3/9/2012, however, the procedure
was difficult due to cervical stenosis and minimal tissue was obtained. Pathology
revealed decidua no villi and patient continues with abdominal cramping and bleeding.
Ultrasound performed on 3/15/2012 revealed an intact gestational sac in left horn of the
uterus extending into the cornua, and patient continued to have cramping and bleeding.
The patient was taken for  a ultrasound-guided D&E with possible diagnostic laparoscopy,
possible exploratory laparotomy. 

PROCEDURE AND FINDINGS: After the patient was properly identified, patient was taken to
the Operating Room whereupon IV anesthesia was administered. The patient was placed in
dorsal lithotomy position, and patient's perineum and vagina prepped and draped in usual
fashion. After a time out was performed a Foley catheter was placed. The bladder was
filled and the transabdominal ultrasound was performed. The gestational sac again was
noted to be in the left horn of the uterus. The exam under anesthesia revealed a 10 weeks
size uterus. The cervix was closed. The Graves speculum was placed in the vagina. A
single tooth tenaculum used to grasp the anterior lip of the cervix and a paracervical
block was placed bilaterally using 1% Xylocaine without epinephrine. The cervix was
dilated without difficulty and the 8 French evacuator was then selected and placed into
the uterine cavity. The products of conception were then evacuated under ultrasound
guidance and a moderate amount of tissue was evacuated. The O curette was placed in the
uterine cavity to remove any residual tissue and the vacuum was then placed to remove any
residual clots or debris. Ultrasound revealed no gestational sac or portions of it in
the uterus after the procedure. The single tooth tenaculum was removed. Good hemostasis
was noted at the cervix. The Graves speculum was removed. The Foley catheter was drained
and removed. All sponge counts were correct. 

The patient was taken to Recovery Room in stable condition. 

Thanks for your help in advance!!


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## tmerickson (Mar 29, 2012)

You wouldn't use an unlisted code. Just use the normal code for treatment of missed abortion. 59820-1st trimester. You will have to append a modifer to it because it sounds like you are in the global period of the first D&C.


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## maine4me (Mar 30, 2012)

Thanks Tesja!


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