Anesthesia Coding Alert
Steer Clear of 'Unspecified' Diagnosis for Abortion
Question: Our provider documented that he performed a D&C for an incomplete abortion. We reported CPT® 00940 with diagnosis Z33.2, but the payer denied the claim and said we needed a consent form because of the abortion. When we double checked, we saw that the case was actually a spontaneous abortion, which doesn›t need a consent form. We›ve had trouble with both 00940 and 01965 in these situations. Is the problem with our diagnosis coding since the documentation doesn›t specify «spontaneous»? California Subscriber Answer: Your problem could lie partly with the diagnosis, but the procedure code might also be off track. Keep these points in mind the next time you code a similar case: Take note: Pay attention to the exclusions listed in your ICD 10. Also, some payers won't accept "unspecified" codes such as Z33.2 (Encounter for elective termination of pregnancy). Check with your physician to learn more about the type of abortion so you can choose a more specific diagnosis.
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