Ob-Gyn Coding Alert

Question: Patient comes into the office for an ob ultrasound and the impression is an incomplete abortion. They go on and schedule the patient for a D&C. When I receive the H&P and op note, it states “missed ab.” I question the provider on what the difference was and why it changed, her response was there is not much difference. When I read in my Codify book, they state the incomplete ab is when products of conception are removed. The missed ab is when a dead fetus/embryo and productions of conception are removed. Should I bill off the path report to determine if this was an incomplete or missed ab?

Texas Subscriber

Answer: This provider needs education for sure. There is a big difference between an incomplete abortion and a missed abortion — both from a procedure coding and diagnostic standpoint. You should wait for the path report in this case. If the fetus was present, code it as a missed abortion. You would use CPT^® code 59820 (Treatment of missed abortion, completed surgically; first trimester) with 10.25 RVUs or 59821 (Treatment of missed abortion, completed surgically; second trimester) with 10.29 RVUs, supported by the diagnosis code O02.1 (Missed abortion).

If placental tissue only, code it as an incomplete abortion. You would use 59812 (Treatment of incomplete abortion, any trimester, completed surgically) with 8.52 RVS, supported by diagnosis from code category O03 (Spontaneous abortion).