Ob-Gyn Coding Alert

Question: If the ob-gyn performs a D&E on a fetal demise at 21 weeks, do we report procedure with CPT^® 59820-22 or with a delivery code 59409?

PREOP DIAGNOSIS: Intrauterine fetal demise at 21w2d POST OP DIAGNOSIS: same 

PROCEDURE: Standard dilation and evacuation/D and E
Indications: ______a 28 y.o. G2P0010 at 21w2d by L=9. She presents today after being diagnosed with an intrauterine fetal demise at her anatomy scan

Procedure:
The patient was taken to the OR with IV running and anesthesia was administered. She was placed in the dorsal lithotomy position. An open-sided speculum was placed in the vagina and 6 cervical dilators and gauzes were removed. The cervix was cleaned with betadine. Cervical block with 10 mL of 1% lidocaine + 5 units vasopressin was administered and an atraumatic tenaculum was placed on the anterior lip of the cervix. Abdominal ultrasound was placed and continued throughout the procedure. Dilation was assessed and found to be inadequate dilation performed with Pratt dilators to 65. A 14 mm suction cannula was advanced and the amniotic fluid removed. Sopher then Bierer forceps were used to evacuate fragmented fetal parts and placenta. Sharp curettage was used to confirm an empty uterine cavity and suction aspiration was repeated. Good hemostasis was noted after the procedure.

All instruments were removed from the vagina and the patient was taken to the post-anesthesia recovery room awake and in stable condition. Products of conception were examined and noted to be complete.

INTRAOPERATIVE SONO: Indication for intraoperative sono: D&E performed with forceps. Realtime ultrasound guidance was performed transabdominally during the procedure. No evidence of uterine or cervical trauma or complications noted. Empty uterine cavity after the procedure.

Kentucky Subscriber

Answer: Because the op note in no way describes a delivery (she would have to be a laboring), you would use the dilation and evacuation (D&E) code for a second trimester missed abortion, which is 59821 (Treatment of missed abortion, completed surgically; second trimester).

You would also code for the ultrasound guidance using 76998 (Ultrasonic guidance, intraoperative).

You should link both of these CPT^® codes to O02.1 (Missed abortion). The assumption is that the ob-gyn diagnosed the patient with fetal demise before the completion of 20 weeks, as the ob-gyn performed this procedure at 21 weeks 2 days.