Ob-Gyn Coding Alert

Question: What is the difference between medical treatment (E/M codes) and surgical treatment of an abortion (59812, 59820, 59821, 59830)? It seems the surgical treatment is either a dilation and curettage (D&C) or vacuum evacuation. However, an ob-gyn in our practice recently had two patients where she used ringed forceps to "tease" retained products of conception out of the uterus. The physician considered the cases below as surgical treatment: Case 1: The ob-gyn treated patient A, at 19 weeks, in the clinic without anesthetic. She had aborted spontaneously but was still having minor bleeding after a few days. Some tissue was visible on exam, so the ob-gyn removed it via ringed forceps. Case 2: The physician gave patient B, at 17 weeks, misoprostol. She delivered a nonviable fetus but the placenta was retained. She was treated in the birthing suite with IV sedation, also with ringed forceps to grasp the retained tissue. Massachusetts Subscriber
Answer: You can consider these to be "reduced services" for the existing codes for surgical treatment of abortion. If this were a spontaneous incomplete abortion, you would code 59812-52 (Treatment of incomplete abortion, any trimester, completed surgically; reduced services) for the removal of the products with ring forceps. If this were a missed abortion situation, then you would report 59820-52 (Treatment of missed abortion, completed surgically; first trimester; reduced services) or 59821-52 (- second trimester; reduced services). You would not be removing products in this fashion for a septic abortion (59830, Treatment of septic abortion, completed surgically) due to the risk of leaving something behind. Bottom line: You should use the surgical codes (rather than an E/M service) to report this type of procedure. Why? The surgical codes more accurately capture the physician work, practice expense and malpractice expense (in the sense that the ob-gyn performed an intervention which involves some risk). If the physician has documented a separate and significant E/M service for evaluation of the spontaneous incomplete abortion, you can also report an E/M service with modifier 25 (Significant, separately identifiable E/M service by the same physician on the same day of the procedure or other service) attached. This does not represent global care.