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ED Coding and Reimbursement Alert

REDAER QUESTIONS:

Use E/M for Spontaneous Abortion

Published on Sat Aug 27, 2005

Question: The patient presented to the ED with abdominal pain and vaginal bleeding. The patient then spontaneously delivered the fetus and placenta. The patient's diagnosis was -complete abortion at 18 weeks- gestational age.- Should I use code 59409 for an 18-week delivery, or is this code intended only for full-term deliveries?


Iowa Subscriber
Answer: No, you shouldn't report 59409 (Vaginal delivery only [with or without episiotomy and/or forceps]) for the delivery, because the ED physician's services are included in the evaluation and management code.

According to the Fall 1993 CPT Assistant, -When a spontaneous abortion that is complete (any trimester) occurs and the physician manages the patient medically, with no surgical intervention, the physician should report the appropriate level of evaluation and management code, dependent on the place where the patient is seen.-
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