# Induced Abortion by Methotrexate



## Stefanie (Feb 26, 2009)

Our OB/Gyn's most commonly do induced abortion by injection of methotrexate in the office and then give the patient a prescription for the vaginal suppositories, having the patient return for follow-up blood work and US to make sure the termination is successful.  

We don't bill this service to the patient's insurance, we request payment in full at the time the induction is initiated.  Knowing that we will add the follow-up services into the pre-payment, we have a set price for this service.  Since there is no surgical code for these services, would it be inappropriate to set up an unlisted procedure (59899) with the full fee and then no charge the follow-up office visits.  


Stefanie Cramer, CPC


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## dmaec (Feb 26, 2009)

wouldn't this service just be an E/M service?  With and injection (of the meds)?  I mean, really - the "only" procedure the physician is providing is the E/M service and injection - or, are they doing more? (besides prescribing the suppositories).  What procedure can you possible justify other than an E/M and injection if that's all that was done?  no other "real" procedure was performed, unless I'm missing something..

and, just out of curiousity - why wouldn't you bill this service to their insurance company? and how much do you charge - for what appears to be an E/M and injection?

I'm thinking there aren't any surgical codes for this, because - it isn't a surgical procedure....


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## dan528i (Mar 2, 2009)

Stefanie said:


> Our OB/Gyn's most commonly do induced abortion by injection of methotrexate in the office and then give the patient a prescription for the vaginal suppositories, having the patient return for follow-up blood work and US to make sure the termination is successful.
> 
> We don't bill this service to the patient's insurance, we request payment in full at the time the induction is initiated.  Knowing that we will add the follow-up services into the pre-payment, we have a set price for this service.  Since there is no surgical code for these services, would it be inappropriate to set up an unlisted procedure (59899) with the full fee and then no charge the follow-up office visits.
> 
> ...




Seems like what you are describing is NON-Surgical TOP. If I am correct, then You are not the only one w/ this problem. We perform the same procedure. (Its much safer then Surgical). Anywasy we used to bill 59855 Seems like the only thing thats close enough by desription w/ one big BUT: 59855 in 2008 CPT -requires HOSPITAL STAY. Therefore, the ins. comp-s that follow CMS guidlines will for SURE deny this code (even with 632dx when appropriate) and the reason beeing is "place of service inappropriate for procedure"  I tried to appeal w/ progress notes and ACOG rulling on TOP w/ 632 dx and ETC. seems like I tried everything. SO IF ANYONE HAS A SOLUTION TO THIS PLEASE HELP !!!!

Thanks in advace.


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## dmaec (Mar 2, 2009)

Daniel - 59855 also requires  "delivery of fetus and secundines" ...(the fetus and placenta are delivered DELIVERED - this does not seem to be the case for this methotrexate abortion) 

I'm thinking, with the metho induced abortion - the ONLY thing you can charge are the office visits and injection of the drug.  This appears to be early abortion - almost like the "PLAN B" abortion.  No other actual procedure is involved by the provider.  (other than the injection or prescription and the office visit)..


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## dan528i (Mar 2, 2009)

Thanks Donna
Like I said 59855 does NOT seem to work (Eventhough thats what the privious coder said would be appropriate). 

Again, thanks for your help.


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## dmaec (Mar 2, 2009)

nods...i'll bet in a few more years (maybe by ICD10)   we'll have a more specific code for these types of elective abortions.....  

it's a tough one to code!


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## Stefanie (Mar 10, 2009)

We don't bill insurance companies because it is an elective service.  We will bill if the patient insists (and then we would split up the services accordingly).

I agree that there is no surgical procedure, but, to get the patient to pay everytime she comes in is extremely difficult and once the patient pays she feels obligated to come back.  If we only bill everytime she comes in, she may not always return for those follow-up visits.  That's why I believe setting up an unlisted code with all the services bundled into it would be more efficient for payment purposes.  The code will include 2 office vists, 2 U/S, 2 pregnancy tests, 2 venipuntures and methotrexate. 

Thanks for all your opinions.


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