Ob-Gyn Coding Alert

Reviewed on May 20, 2015

If you report the wrong diagnosis code, you may lose reimbursement.

If you label a nonelective abortion as "complete" or "incomplete," you may automatically establish your CPT® coding options for the ob-gyn's services, regardless of what he or she may have done.

Generally, you will designate nonelective abortions at fewer than 22 weeks gestation as spontaneous incomplete (634.x1), spontaneous complete (634.x2) or missed (632). Although technological advances enable physicians to detect pregnancy in its earliest stages, coding for nonelective abortions has become more complicated.

When a patient presents with no prior pregnancy diagnosis, the ob-gyn can use tools such as ultrasound and beta subunit HCG (human chorionic gonadotropin, a pregnancy test that helps determine the stage of pregnancy) to confirm pregnancy and decide how far it has progressed. When a patient presents with a nonelective abortion, diagnosis and procedural coding can be a challenge, especially if the pregnancy terminated very early on.

Women frequently do not seek medical attention for a delayed menstrual cycle because they may not be aware that conception occurred. If the ob-gyn diagnoses a pregnancy and it later terminates, either spontaneously or by induction, you should report the related physician services. And the diagnosis coding can be critical to ensuring proper payment for the doctor's work.

Patient's Diagnosis Affects CPT® Coding

When determining the correct CPT® code for treating a nonelective abortion, the first question is whether the ob-gyn performed surgery to complete the process. If the patient presents with a complete spontaneous abortion, no products of conception remain in the uterus. You would likely report an E/M code (99201-99215, Office or other outpatient visit ...) because he doesn't perform any type of procedure to treat the patient's symptoms, coding experts say. You would link the E/M service to 634.x2 on the CMS-1500 form.

If the patient has an incomplete spontaneous abortion, however, she would still have products of conception retained, though they may be expected to pass naturally without surgical intervention. If the products of conception do not evacuate on their own, the ob-gyn may perform a dilation and curettage (D&C). In this case, you would submit 59812 (Treatment of incomplete abortion, any trimester, completed surgically) with the incomplete spontaneous abortion diagnosis (634.x1).

But, if the patient has a missed abortion, products of conception always remain in the uterus. As with incomplete spontaneous abortions, the ob-gyn may have to evacuate a dead embryo or fetus from the uterus through D&C. But in the case of missed abortions, you would report 59820 (Treatment of missed abortion, completed surgically; first trimester) or 59821 (... second trimester) instead of 59812 because 59820-59821 more specifically describe the service performed. In this case, you would link the procedure code to 632.

Under the CPT® Guidelines for 59820, when reporting delivery only services, "report inpatient post delivery management and discharge services using E/M codes ... Medical problems complicating labor and delivery management may require additional resources and should be identified by utilizing [E/M codes] in addition to codes for maternity care." In other words, you should itemize any prenatal visits that occurred before the surgery with the appropriate E/M code using the diagnosis that correlates (for example, V22.x for normal pregnancy or 641.8x for other antepartum hemorrhage).

The spontaneous incomplete and missed abortion diagnoses indicate that retained products of conception required surgical removal. And a complete spontaneous abortion ICD-9 code implies that there are no retained products of conception, and therefore you shouldn't report a procedure code.

ICD-10: When your diagnosis coding system changes in 2013, you will have to shift your coding options:

Code 634.91 will become O03.4 (Incomplete spontaneous abortion without complication).

Code 634.92 will become O03.9 (Complete or unspecified spontaneous abortion without complication).

Code 632 will become O02.1 (Missed abortion).

Code 641.83 will expand into three options based on trimester:

• O46.8X1 (Other antepartum hemorrhage, first trimester)
• O46.8X2 (..., second trimester)
• O46.8X3 (... , third trimester)

Instead of V22.0, you will report Z34.00 through Z34.03 (Encounter for supervision of normal first pregnancy...). Like above, you'll choose your code by trimester.

Code V22.1 will become Z34.80 through Z34.83 (Encounter for supervision of other normal pregnancy...). You'll choose your code by trimester.

Bonus Challenge: What About Abnormal Products?

Occasionally, a patient enters the exam room unaware that she is pregnant, and the diagnosis is something other than a missed abortion. In this case, special procedural codes apply.

For example, the ob-gyn performs a dilation and curettage (D&C) for a blighted ovum (631, Other abnormal product of conception). In this case, the nonobstetrical D&C code (58120, Dilation and curettage, diagnostic and/or therapeutic [nonobstetrical]) doesn't seem right. The correct code, rather, depends on when -- or if -- the ob-gyn discovered the blighted ovum and pregnancy.

The treatment for a blighted ovum, which is a fertilized egg that fails to develop into a fetus, may be the same as a missed abortion, but only if the doctor has confirmed a pregnancy. For example, a patient may come in with unexplained vaginal bleeding before she realizes that she may have been pregnant, and a pregnancy test comes back negative. If this is the case, and there is a negative pregnancy test, you should report 58120 even if the pathology report indicates a blighted ovum after the fact.››››››

On the other hand, if the ob-gyn has diagnosed the patient as pregnant either prior to or at the same visit and she begins to bleed, she may spontaneously abort, or she may require surgery to remove the retained products of conception. The blighted ovum may not become apparent until the pathology report comes back, but because there was a positive pregnancy test, you should report 59812 (Treatment of incomplete abortion, any trimester, completed surgically).

Although unusual, a patient with a blighted ovum may only complain of a missed period. The ob-gyn will likely order a pregnancy test and perform an ultrasound. If the pregnancy test is positive, and the ultrasound reveals a blighted ovum (but no symptoms of abortion, for example, discharge or bleeding), the physician will likely perform a D&C. In this case, you would report 59820 or 59821 with 631. Submit the ultrasound with 76856 (Ultrasound, pelvic [nonobstetric], B-scan and/or real time with image documentation; complete).

With a blighted ovum, you are not inducing an abortion because there is no embryo or fetus. Rather, you may be helping along what nature has already started.

ICD-10: When your diagnosis coding system changes in 2013, you will have to shift your coding options. Code 631 will expand into O02.0 (Blighted ovum and nonhydatidiform mole) or O02.8 (Other specified abnormal products of conception).