Ob-Gyn Coding Alert

Answer: You are correct, the global obstetric package code would not be appropriate to bill in the case where the fetus died in utero prior to 20 weeks, zero days gestation. In this case, you will bill the total number of antepartum visits using the methods outlined in CPT. Meaning if she was seen only one, two or three times, each visit is billed using an evaluation and management (E/M) outpatient code (99241-99245).

If she was seen up to six times, 59425 (antepartum care only; 4-6 visits) would be reported, but using only a quantity of one. If she was seen seven or more times, 59426 (antepartum care only; 7 or more visits) would be reported instead. Again, the quantity would be one. CPT also has a code that specifically describes the delivery performed on this patient. The code 59856 (induced abortion, by one or more vaginal suppositories with or without cervical dilation, including hospital admission and visits, delivery of fetus and secundines; with dilation and curettage and/or evacuation) is used when the physician induces abortion (which is the case even with fetal demise) using vaginal suppositories and then goes on to do a D&C for retained placenta.

This code includes the hospital admission, the delivery and surgery following it, and follow-up inpatient hospital visits through discharge. Under the Medicare RBRVS fee schedule, the code also has a 90-day global period, so outpatient follow-up for the delivery and surgery also will be included. But private payers may have assigned a different global period, perhaps lasting only six weeks.

Source is Melanie Witt, RN, CPC, MA, former program manager for the American College of Obstetricians and Gynecologists (ACOG) department of coding and nomenclature and an independent coding educator in Fredericksburg, Va.