Anesthesia Coding Alert

Question: Our provider documented that he performed a D&C for an incomplete abortion. We reported CPT 00940 with diagnosis ICD-9 637.91, 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"?

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:

• You shouldn't report 00940 (Anesthesia for vaginal procedures [including biopsy of labia, vagina, cervix, or endometrium]; not otherwise specified) for D&Cs with abortion. Instead, report 00940 only when the physician performs a D&C.
• When coding for a spontaneous abortion, look to the 634.xx (Spontaneous abortion) family for diagnoses.
• Code 01965 (Anesthesia for incomplete or missed abortion procedures) is correct for a spontaneous abortion.

Some payers won't accept "unspecified" codes such as 637.91 (Unspecified type of abortion without complication, incomplete). Check with your physician to learn more about the type of abortion so you can choose a more specific diagnosis.