Hmm.. I am a new coder to OBGYN and I had a similar case. I asked ACOG how it should be coded and they replied E/M + 59414 placenta. Do you think the answer is based on the Reason for induced delivery (IOL)? Please let me know if my conclusions (from response above and ACOG) are correct?
----If IOL is for fetal demise (less than 20w) via oral misoprostol, then we code E/M.
----If IOL is for Fetal abnormalities, mother's health (less than 20w) via oral miso, then we code E/M + 59414?
Here is my correspondence with ACOG:
"On Tue, 23 Mar at 12:05 AM , Natasha Lage <
natasha.lage@ wrote:
"Hello, could you please help me understand/pick the right CPT for Induced termination of pregnancy at 19 weeks for fetal multiple problems. Pt was given buccal misoprostol prior. Pt delivered stillborn fetus. I know if 20w or more, that will be a Delivery CPT.
My dilemma is that CPT 59855 is for Vaginal suppositories (prostaglandin) but my patient received it orally. Will it qualify for 59855? Sometimes I see notes when MD does not specify the route of Misoprostol/Misopresol; do I need to query the MD?
Thank you very much for your assistance. I am looking forward to hearing from you.
From: American College of Obstetricians and Gynecologists <
answer@acogcoding.freshdesk.com>
Sent: Wednesday, March 24, 2021 1:39 PM
To: Lage, Natasha <
Natasha.Lage@
Subject: Re: Response Received - [Ticket #547] Induced Termination by Misopostol -Delivery at 19weeks
Dear Natasha Lage,
This email is in response to your coding question: Induced Termination by Misopostol -Delivery at 19weeks.
You are correct that if the patient delivers on or after 20 weeks 0 days, a delivery service would be reported. Unfortunately, there is no code available to explicitly describe this particular circumstance. Therefore, it would be reported as follows:
- E/M services (office/outpatient or observation/inpatient), along with prolonged services codes, if appropriate
- 59414 Delivery of placenta
- Appropriate E/M service codes for any follow up services
59855 can only be used when the procedure is initiated vaginally. If the route of administration is unclear, it will be necessary to query the physician.
It will be necessary to add a 25 modifier to any E/M service provided on the same day that the placenta is delivered.
Please let us know if we can be of further assistance.
Ticket URL: https://acogcoding.freshdesk.com/helpdesk/tickets/547
Sincerely,
ACOG Health Economics & Practice Management Team""
I will greatly appreciate all of your responses!
Thank you.