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. An ob-gyn in our practice, however, 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 and with ringed forceps to grasp the retained tissue.

Massachusetts Subscriber

Answer: You can consider these -reduced services- of surgical treatment abortion codes.

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 was a missed abortion situation, then you would report 59820-52 (Treatment of missed abortion, completed surgically; first trimester) or 59821-52 (- second trimester).

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 the E/M code 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.