# stillborn delivery at 20 5/7 weeks



## sknapp56 (Nov 20, 2013)

For a patient who had a fetal demise at 20 5/7 weeks due to fetal abnormalities and oligiohydraminos Cytotec was used for induction and still born fetus delivered and patient was brought to the OR for retained placenta. Would you bill the 59410 Vaginal delivery with post partum care and the 59414-removal of placenta?  ACOG guidelines say after 20 weeks use delivery code and ICD-9 defines it as 22 weeks. I think it should be delivery code with fetal demise 656.41 code and 59414- with 667.04 code. Would like other coder opinions.


----------



## Thouvenel (Dec 4, 2013)

I have always used the ICD-9 as the guideline, and billed 59400 with the 632.  I'm not sure it really matters which diagnosis you use unless your carrier tells you otherwise.  However, you can't bill the 59414 that is part of the global service.  Where you are going to have an additional charge is since the patient was taken to the OR for the retained placenta, how was it removed?  By D&C?


----------



## rachdogg67 (Apr 11, 2022)

Can we bill attendance at delivery for stillbirth under Mom, should we use a hospital care code since baby isn't registered if still born.


----------



## nielynco (Apr 13, 2022)

sknapp56 said:


> For a patient who had a fetal demise at 20 5/7 weeks due to fetal abnormalities and oligiohydraminos Cytotec was used for induction and still born fetus delivered and patient was brought to the OR for retained placenta. Would you bill the 59410 Vaginal delivery with post partum care and the 59414-removal of placenta?  ACOG guidelines say after 20 weeks use delivery code and ICD-9 defines it as 22 weeks. I think it should be delivery code with fetal demise 656.41 code and 59414- with 667.04 code. Would like other coder opinions.


First off, you are using the old ICD9 codes, not ICD10 so is this a reprise of a very old question?  Also ICD10 rules now indicate that early fetal demise is before 20 completed weeks so at 20 5/7 you are past that requirement.  You also cannot bill a delivery code with 59414 as the delivery of the placenta is included.  You may be able to bill 59200 if the induction was done the day before delivery, but all deliveries otherwise include induction by any method.  So with this scenario, only 59410 should be billed (assuming no postpartum care was given by this provider), or possibly 59400 if antepartum care was included, but with a modifier -52 for very reduced visits.  If you are billing 59140, you can bill 59160 for postpartum curettage for the retained placenta.


----------

