Ob-Gyn Coding Alert

Tip: Ask, -Did the fetus death occur prior to 20 or 22 weeks?-

Thankfully, not all abortion diagnosis codes require the tricky fifth digit. Sort through these three- and four-digit ICD-9 codes before you tackle the fifth-digit possibilities " you may save yourself time and headaches.

630 " Hydatidiform mole

A hydatidiform mole results from overproduction of the tissue that is supposed to develop into the placenta. The placenta normally feeds a fetus during pregnancy. In this condition, the tissues develop into an abnormal growth, called a mass. Often, the patient has no fetus at all, says Melanie Witt, RN, CPC-OGS, MA, an ob-gyn coding expert based out of Guadalupita, N.M.

631 " Other abnormal product of conception

A blighted ovum is a common cause of early pregnancy loss. It occurs when a fertilized egg develops a placenta and membrane but no embryo. A blighted ovum usually occurs in the first few weeks of pregnancy, and an ultrasound will show an empty gestational sac. Blighted ovum is often due to chromosomal abnormalities in the fertilized egg.

632 " Missed abortion

Good news: -Our physicians mostly deal with missed abortions, so the coding is pretty simple to me,- says Rebecca Lopez, CPC, certified coder for Bright Health Physicians in Whittier, Calif.
A missed abortion is the in utero death of the embryo or fetus before the 22th week of gestation with retained products of conception.
Watch out: Your ob-gyn may refer to missed abortions as -blighted ovum,- -anembryonic pregnancy,- or -fetal demise.- However, from an ICD-9 perspective, you would code the blighted ovum or anembryonic pregnancy with 631. Instead, you should use 632 for a fetus- death prior to 22 completed weeks, rather than 20 weeks.

638.x " Failed attempted abortion

In a failed attempted abortion, the patient attempted at a previous encounter an elective abortion that failed to remove the products of conception. As a result, complications may have ensued that the ob-gyn must treat at this encounter, Witt says.

639.x " Complications following abortion and ectopic and molar pregnancies

Once your ob-gyn has treated or managed an abortion event and completed it at a previous encounter (reported with 630-633 or 634-638), you should report any complication of that abortion at a subsequent visit using 639.
-Be sure you know the difference between 630-633 (Ectopic and Molar Pregnancy) and 634-639 (Other Pregnancy with Abortive Outcome),- Lopez says. These differences matter to the selection of the appropriate
ICD-9 code.