Ob-Gyn Coding Alert

Discover the difference between spontaneous and threatened

A -spontaneous abortion- (miscarriage) is the end of a pregnancy at a stage where the embryo or the fetus is incapable of surviving, generally defined at a gestation of prior to 20 weeks.
Unlike the threatened abortion codes, ICD-9 does not apply the 22-week criterion to a spontaneous abortion, says Melanie Witt, RN, CPC-OGS, MA, an ob-gyn coding expert based out of Guadalupita, N.M. This type of abortion is a process that can be divided into four stages:
 - threatened
 - inevitable
 - incomplete
 - complete.
Threatened: A threatened abortion consists of any vaginal bleeding before 22 completed weeks of gestation without cervical dilatation or change in cervical consistency. Usually, no significant pain exists, although mild cramps may occur, but the patient has not expelled any products of conception. You should not code this event as a spontaneous abortion but rather report it as a threatened abortion (640.xx, Hemorrhage in early pregnancy) or 649.5x (Spotting complicating pregnancy).
Inevitable: Similarly, the inevitable abortion is an early pregnancy event usually characterized by vaginal bleeding, uterine cramping, dilatation of the cervix, and possibly rupture of the membranes, but no tissue has passed yet. You should code this using category 640.xx.
Incomplete: An incomplete spontaneous abortion is a pregnancy associated with vaginal bleeding, dilatation of the cervical canal, and passage of some conception products. Usually, the cramps are intense, and the vaginal bleeding is heavy. Patients describe passage of tissue, or the physician observes evidence of tissue passage within the vagina. An ultrasound, if performed, will confirm that some of the conception products are still present in the uterus.
Complete: A complete abortion is a completed miscarriage. Typically, a history of vaginal bleeding, abdominal pain and tissue passage exists. After the tissue passes, the patient notes that the pain subsides and the vaginal bleeding significantly diminishes. The examination reveals some blood in the vaginal vault, a closed cervical os, and no uterus tenderness.