Technological advances enable physicians to detect pregnancy in its earliest stages but make coding for spontaneous or missed abortions more complicated. When a patient presents with no prior pregnancy diagnosis, tools such as ultrasound and beta subunit HCG (human chorionic gonadotropin, a pregnancy test that helps determine the stage of pregnancy) confirm pregnancy and enable physicians to determine how far it has progressed. When a patient presents with a pregnancy that has already terminated through nonelective abortion, coding for diagnosis and procedural care can be a challenge, especially for very early-term pregnancies. Often, women who did not seek medical attention for early diagnosis of pregnancy will not identify a delayed menstrual cycle as the loss of a pregnancy and will not be aware that conception occurred. If a pregnancy is diagnosed and terminates, either by spontaneous or induced means, the abortion codes should be used to report the related physician services.
Abortion Terminology
Familiarization with the common types of abortions is the first step to assigning the right ICD-9 and CPT codes.
Complete: The complete expulsion or extraction from its mother of a fetus or embryo; complete expulsion from the uterus of any other product of conception.
Elective: Without medical justification but done in a legal way.
Incomplete: Part of the products of conception have been passed but part (usually the placenta) remains in the uterus.
Induced: Expulsion of the fetus and products of conception brought on purposefully by drugs or mechanical means.
Inevitable: Characterized by rupture of the membranes in the presence of cervical dilation in a pre-viable pregnancy.
Missed: Death of the fetus in utero prior to 22 weeks, with retention of the products of conception.
Septic: An infectious abortion complicated by fever, endometriosis or parametritis.
Spontaneous: An abortion that has not been induced artificially. The term is usually limited to pregnancies of less than 22 weeks gestation.
Editors note: CPT codes for induced abortion (59840-59857) do not distinguish between elective (not medically necessary) or nonelective (medically necessary) abortions. ICD-9 codes 634.x-637.9 describe spontaneous (nonelective) (the fourth digit indicates the contributing complication), legally induced (elective), illegally induced (elective) and unspecified abortion (nonelective).
Spontaneous vs. Missed Abortion
Carla Bryan, CPC, practice manager at Womens Care, a two-physician, one-nurse midwife
ob-gyn practice in Hartsville, S.C., says that when determining the right CPT code for a nonelective abortion, the first parameter is whether surgery was required to complete the process. If the patient presents with a spontaneous abortion that is complete (meaning there were no products of conception retained in the uterus), we treat the patient and code it as an evaluation and management (E/M) visit, with no other CPT code, [...]
