Ob-Gyn Coding Alert

Question: A 19.5-week pregnant patient arrived in the emergency department with bleeding and cramping.-She had a fetal demise.-The ob-gyn did not perform any dilation and curettage.-She says it was a complete spontaneous abortion (634.92) in which she delivered the baby and the placenta by manual extraction. She says this was more than an E/M. Since we are just a half-week short of 20 weeks, can I use 59410?-My physician also admitted the patient for less than 24 hours of observation.-Can I charge for that provided we don't use a delivery code?

Texas Subscriber

Answer: No, you should not use 59410 (Vaginal delivery only [with or without episiotomy and/or forceps]; including postpartum care). According to the American College of Obstetricians and Gynecologists (ACOG), you cannot report any delivery of a pregnancy that lasts less than 20 weeks 0 days with the delivery codes (for example, 59410) unless the baby is born alive.-Also, the CPT manual clearly advises you to code the medical treatment of a spontaneous abortion using E/M codes.-

Therefore, you should report all the E/M services provided on the date of the abortion, if applicable (such as observation care, 99218-99220 or 99234-99236; or initial hospital care, 99221-99223; plus any prolonged face-to-face services, 99354-99357). The physician can also bill for subsequent hospital care (99231-99233) and discharge day management (99217, 99238-99239) because he is not also reporting the delivery code.

Reporting prolonged face-to-face services depends on the additional time the physician documented he spent with this aborting patient and the code you billed as the day's primary service. For instance, you cannot bill direct prolonged services unless the ob-gyn documented that she exceeded the basic E/M service by 30 minutes.

So, you cannot bill for prolonged services with an observation code (99218-99220 or 99234-99236) because these codes do not describe a typical time that your physician must have exceeded before you can bill prolonged services. But if your physician billed for an initial inpatient hospital service (99221-99223) on the date of the prolonged service, you can report 99356-99357 for the prolonged inpatient face-to-face service and expect payment for it.