Ob-Gyn Coding Alert

Question: For a patient who had a fetal demise at 20 5/7 weeks due to fetal abnormalities and oligohydramnios, the ob-gyn used Cytotec for induction. The still born fetus was delivered, and the patient was brought to the operating room (OR) for retained placenta. Would you bill the 59410 (Vaginal delivery with postpartum care) and the 59414 (removal of placenta)?

Montana Subscriber

Answer: ICD-10-CM rules now indicate that early fetal demise is before 20 completed weeks, so at 20 5/7 weeks, you are past that requirement. But since this age would allow you to bill for a delivery, you cannot also bill code 59414 (Delivery of placenta (separate procedure)), as this procedure is included.

You may be able to bill 59200 (Insertion of cervical dilator (eg, laminaria, prostaglandin) (separate procedure)) if the ob-gyn performs the induction the day before delivery, but all deliveries otherwise include induction by any method.

So, with this scenario, you should bill only 59410 (Vaginal delivery only (with or without episiotomy and/or forceps); including postpartum care) (assuming no postpartum care was given by this provider). You can also bill 59160 (Curettage, postpartum) for postpartum curettage for the retained placenta.

Another possibility is 59400 (Routine obstetric care including antepartum care, vaginal delivery (with or without episiotomy, and/or forceps) and postpartum care) if you’re including antepartum but with a modifier 52 (Reduced services) for very reduced visits.