ED Coding and Reimbursement Alert

Question: A patient presented in the emergency department, and the physician discovered through a history of present illness that she was 16 weeks pregnant. She was having a spontaneous abortion, so our doctor started her on Pitocin and delivered the fetus and the placenta (which was 16 weeks old, as we discovered during the exam). Should we use only the code for vaginal delivery, or just report an E/M level?
     
Wyoming Subscriber

Answer: While the vaginal delivery code (59409,  Vaginal delivery only [with or without episiotomy and/or forceps]) is intended for routine deliveries, you can also use it to describe non-full-term pregnancies. In order to report the abortion codes (59812-59857), the treatment generally requires surgical/procedural intervention.

In this case, the patient was having a spontaneous abortion that the doctor assisted/facilitated with medical means (Pitocin). There is direction at the beginning of the abortion section in CPT that you should report medical abortions using E/M codes. You should probably roll this work into an E/M code -- but take note that the nature of the presenting problem is high severity with high risk.