Ob-Gyn Coding Alert

Question: Should I report CPT^® code 59855 for the following scenario? I am not sure if this code is correct, because the patient was seen in observation and not admitted as an impatient. The fetus expelled, but the note does not state that the patient was in labor.

Note: _____ is a 35yo G3P2 at 15w6d with fetus with multiple anomalies including diaphragmatic hernia with heart displaced into right hemithorax, possible endocardial cushion defect, and hydronephrosis. She also has h/o c/s x 2. Patient presents for induction/termination.

Patient was consented for procedure and mifepristone was administered on 2/18. On admission to MB 2/19, consents and plan were confirmed. Patient received 400mcg of misoprostol buccal. She used Toradol and Fentanyl for pain control. Approximately 3 hours after administration of the misoprostol, the fetus was expelled. Cord was clamped and cut, and fetus was handed off to be prepared for a viewing with the patient at a later time. Gentle traction was placed on the umbilical cord, but the placenta did not deliver immediately. A second dose of misoprostol 400mg buccal was given.

Placenta was delivered intact at 2035. Perineum was inspected and no perineal lacerations visualized. Sponge, lap, and needle counts were correct. Patient tolerated procedure well with no complications.

What should I report?

Kentucky Subscriber

Answer: In order for her to expel the fetus, she would have had to experience labor pains. That is the purpose of the drugs she was given.

In this case, there is no evidence the medication was given via a vaginal suppository, so you should not use 59855 (Induced abortion, by 1 or more vaginal suppositories (eg, prostaglandin) with or without cervical dilation (eg laminaria), including hospital admission and visits, delivery of fetus and secundines).

Instead, you should bill the E/M services (99212-99215, Office or other outpatient services for the evaluation and management of an established patient …) and prolonged services codes (99354-99360). Be sure to get better timing information to go on as approximately three hours does not also cover the additional time for the delivery of the placenta and so on.

Heads up: You may not bill the delivery of placenta code (59414, Delivery of placenta (separate procedure)), as there was no surgical intervention.