# Placenta surgically delivered after vaginal birth



## twinpw (Jan 3, 2014)

Hi, everyone. I have a tough one, and as a new coder, unsure how to code this one. A 40+ yr old had in vetro fertilization. She has had a past C-section, with  hx of retaining her placenta and hx of postpartum hemmorage.Was to have a scheduled C-section, but comes in in active labor and delivers vaginally.(Dr was in to do an emergent C-section on another pt, checks in on this pt and supports vaginal delivery, finished the other C-section while this pt delivers and when dr is done with the other emergent C-section,  rushes back to check this pt--no other doc since  it's a small town) Pt delivers, but does not expell the placenta. Pt losses a lot of blood in the first hour after delivery and became hypotensive and doc arrives as as soon as he completed the other surgery. At the same time, rapid response team had been called and had arrived due to pt's condition. More fluids given and a blood transfusion given and pt taken to OR for placenta removal. Procedure listed as "Examination under anesthesia and manual exploration of the endometrial cavity and manual removal and extraction of placenta". Findings "retained placenta with possible mild placenta accreta from in vitro fertilization. Midline episiotomy that was repaired under anesthesia". Total blood loss approx 1,500 ml and 2 units RBC given. 
So, I am thinking I need to bill the elderly pregnancy (659.62), the High risk pregnancy (V23.0) and vaginal birth (V27.0) with 59400. Then I get lost. ? what procedure code for the placenta removal, and thinking 666.02 and 669.22 for the diagnosis's. I would appreciate any help and please explain the answers so I can understand how to do this correctly. Thank you to a everyone in advance, Pam


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## Twaiting16@yahoo.com (Jan 3, 2014)

*my response to Delivery of placenta*

I agree with you using the code 54900.  I am thinking that you can use code 59414 for the delivery of the placenta.  The one doubt I have about this code is that it is a "(separate procedure)".  
I don't know if this helps you.  I would like to hear other coder's responses.  
Teresa


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## Bready (Jan 6, 2014)

I would use 59610(vaginal delivery after previous C section) dx: 654.21; 659.61; V23.85(pregnancy resulting from in vitro) and V27.0

and 59414-78 with 666.04

looks like there will be enough documentation to support the 59414. be ready to defend it if questioned.  

others may have different opinions but this is how I would go.  hope it helps some.


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## twinpw (Jan 7, 2014)

Thank you both for for your input. Bready, like your explanation, thank you for your help. Pam


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