Ob-Gyn Coding Alert

Here’s why you’ll apply ‘0’ — not ‘1’ or ‘2’ — to medically induced abortions.

When a claim for an abortion hits your desk, you should know that some abortion diagnoses require fifth digits — and if you don’t submit the right one, your payer could deny your claim for lack of medical necessity.

Don’t fret though. Delve into these abortion codes that need five digits, and your abortion coding will be on the spot every time.

Step 1: Get to Know What 5th Digits Mean

Some abortion codes require a fifth digit of 1 (incomplete), 2 (complete) or 0 (unspecified in the documentation whether it was incomplete or complete, or not applicable). But the application of these fifth digits will differ depending on the type of abortion, says Melanie Witt, RN, COBGC, MA, an ob-gyn coding expert based out of Guadalupita, N.M.

Key: Know your ICD-9 Chapter 11 guidelines. You’ll assign the fifth digit based on the status of the patient at the beginning of the encounter. A fifth digit of 1 (incomplete) indicates that the uterus has not expelled all of the products of conception, according to the current ICD-9-CM Official Guidelines for Coding and Reporting (Chapter 11, Section K.1.). A fifth digit of 2 (complete) indicates that all conception products are gone from the uterus prior to the episode of care.

Step 2: Apply 5th Digits to Spontaneous Abortion Codes

When using the abortion codes for spontaneous abortion (634.xx), code based on these two rules:

When the spontaneous abortion is incomplete, the ob-gyn may intervene surgically to remove the remaining products (59812, Treatment of incomplete abortion, any trimester, completed surgically) and will link this procedure to the reason for doing it. This will be an incomplete spontaneous abortion, 634.11 (Spontaneous abortion incomplete complicated by delayed or excessive hemorrhage) if she has bleeding. You’ll apply the fifth digit of 1 because she expelled part of the products prior to the current encounter.

ICD-10: When your diagnosis system changes, 634.11 will become O03.1 (Delayed or excessive hemorrhage following incomplete spontaneous abortion).

In the case of a complete spontaneous abortion, you will report 634.92 (Spontaneous abortion complete without complication) for the encounter if the physician notes no complications of the complete abortion and determines she has expelled all the products of conception prior to the current encounter.

ICD-10: When your diagnosis system changes, 634.92 will become O03.9 (Complete or unspecified spontaneous abortion without complication).

Step 3: Review the Induced Abortion Codes

Now look at the codes for a legally induced (meaning either elective or therapeutic), self-induced or unspecified abortion (635-637).

The fifth digits of incomplete or complete can easily apply to either a self-induced or unspecified abortion (in which some of conception products could have been expelled prior to a current visit).

Advice: The more specific ICD-9 codes you have for this area the better.

Zero in on legally induced abortions: However, a legally induced abortion by definition implies that no products of conception were passed prior to the visit — at which, the physician handles the abortion surgically or medically manages it for the first time. Therefore, your only choice for a fifth digit would be a 0 since because this represents what is known at the beginning of the visit, Witt says.

In other words, if the encounter is to perform a surgical abortion (for instance, 59840, Induced abortion, by dilation and curettage), you cannot assign a fifth digit of 1 (incomplete). The reason is that prior to the visit, the patient had no evidence of an incomplete abortion. At the end of the encounter, the physician will deem the abortion complete in almost every case, but this was not the status at the beginning of visit. You therefore should assign 635.x0 (Legally induced abortion …) to the encounter.

ICD-10: When your diagnosis system changes, an elective termination without complications does not require an indication of whether it is incomplete or complete and becomes a single diagnosis: Z33.2 (Encounter for elective termination of pregnancy).

Rationale: “This would fall under the additional rules in ICD-9 guidelines that for abortions you must code what is known at the beginning of the visit,” Witt says.

But if the ob-gyn medically induces the patient’s abortion, the circumstance at the visit’s end is less clear.

Examine medically induced abortions: A medical abortion is one that is brought about by taking medications that will end a pregnancy. The ob-gyn can use either of two medications, mifepristone or methotrexate, for medical abortion. The patient takes each of these medications together with another medication, misoprostol, to induce an abortion. This can take anywhere from about a day to three-four weeks from the time a woman takes the first medication until the medical abortion is complete.

Therefore, just as with a surgical abortion, you should apply a fifth digit of 0 (unspecified in the documentation whether it was incomplete or complete). Your ob-gyn cannot document a complete or incomplete abortion at this visit. For instance, you’ll use 635.90 (Legally induced abortion unspecified  without complication) if the patient has no complications at the time of the encounter. You can code for follow-up to a medically induced abortion prior to verification of a complete abortion using the “incomplete” fifth digit. 

ICD-10: As with the surgically induced abortion, when your diagnosis system changes, 635.90 will become Z33.2 (Encounter for elective termination of pregnancy).