Ob-Gyn Coding Alert

Question: Can I bill for the manual removal of the placenta when the ob-gyn used forceps to pull it out after an incomplete miscarriage? Code 59414 seems to be for use after the patient has delivered.

Florida Subscriber

Answer: If the fetus is less than 20 weeks 0 days gestation, you cannot bill for any delivery codes. This would include 59414 (Delivery of placenta [separate procedure]). In this case, you would treat the situation as an incomplete abortion.

Code 59812 (Treatment of incomplete abortion, any trimester, completed surgically) may seem like a good option. But most payers will be looking for surgical scraping or removing of the remaining tissue, not pulling the placenta out manually.

Consequently, you should report this service with an E/M code (99201-99205 for a new patient, or 99211-99215 for an established patient) and add a prolonged physician service (99354-99357) if the procedure took considerable time to complete -- that is, at least 30 minutes beyond that which the E/M code you report lists as the typical time.

 -- The answers for Reader Questions and You Be the Coder were provided by Melanie Witt, RN, CPC, MA, an ob-gyn coding expert based in Fredericksburg, Va.; and Harry L. Stuber, MD, an independent gynecologist based in Cookeville, Tenn.