Ob-Gyn Coding Alert

The vast majority of female Medicare beneficiaries are beyond their childbearing years, but some younger women disabled by injury or illness are eligible for the program. Hence, last October 1, 1998, Medicare began paying for abortions under either of two circumstances:

the pregnancy was a result of rape or incest; or

the pregnancy would place the women, who must be suffering from a physical disorder, injury or illness, in danger of death unless an abortion is performed.

However, effective July 1, 1999, the Medicare modifier -G7 (pregnancy resulting from rape or incest or pregnancy certified by a physician as life threatening) must be appended to the appropriate procedure code (59840-
59857) or the claim will be denied. When you submit claims with this modifier be sure that the documentation and the reported diagnoses support abortion under the Medicare criteria.