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Ob-Gyn Coding Alert

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ACOG, Payers Differ on 21 Week Fetal Demise Dx

Published on Sat May 09, 2009

Question: A pregnant patient presents at 21 weeks with a fetal demise. Our ob-gyn wants to charge for delivery but the fetus was only 21 weeks. This is the op note:
Patient received second dose of 200 microgram of Cytotec at 3:30, and she started to have uterine contractions and expelled the whole gestational sac with placenta attached to it. Membrane was intact, and the baby was inside. Uterus was palpated and found to be well contracted. Small clot was removed from the vagina. The sac was opened and the fetus was inside with the cord wrapped around one arm and the neck. Patient tolerated the procedure well and was transferred to postpartum floor. I-m thinking that if I use the incorrect diagnosis, the insurance company will deny it. Should I use 632 (missed AB) instead of 656.4 (fetal death intrauterine 22 weeks and after)? Tennessee Subscribe Answer: The answer depends [...]
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