ED Coding and Reimbursement Alert

Question: A 35-year-old patient reports to the ED having a spontaneous abortion. The fetus, approximately 7 cm, was expelled but still attached by the partially severed umbilical cord. The ED physician gently massages the mother's abdomen, and removes the placenta. After ensuring the patient was not experiencing any complications, the physician releases the patient. Is the placenta delivery part of the E/M service, or can I code it separately?

Kansas Subscriber

Answer: From a technical coding perspective, if the ED physician manually removes the placenta, you could code it separately. If you have evidence of the physician's involvement, report the following:

• 59414 (Delivery of placenta [separate procedure]) for the placenta delivery

• the appropriate ED E/M code, such as 99284 (Emergency department visit for the evaluation and management of a patient, which requires these 3 key components: a detailed history; a detailed examination; and medical decision making of moderate complexity ...)

• modifier 25 (Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service) appended to the E/M code to show that the E/M was separate from the placenta delivery

• 634.90 (Spontaneous abortion; without mention of complication; unspecified) appended to 59414 and the E/M to represent the patient's condition.

Note: If the physician merely supervised the placenta removal, you should consider the work part of the ED E/M service and leave 59414 off the claim.

-- Reader Questions and You Be the Coder reviewed by Michael A. Granovsky, MD, CPC, FACEP, president of MRSI, an ED coding and billing company in Woburn, Mass.