Wiki Induced Delivery at 17 weeks due to premature rupture of membranes.

[natashalage]

Hello Coding Community. I will greatly appreciate your advice on coding this type of delivery!
Pt had premature rupture of membrane at 17 weeks. Than Mife. was given to induce the labor. Pt delivered a still born baby.
I cannot code as a Delivery because it's not 20week and looks like a Delivery was induced, should I code as delivery of Placenta 59414 ? It's not an abortion and if it's not a delivery than what is left?.. placenta?
Thank you very much!
G1P0 who presented at 17w4d. She was admitted on 9/4/2021 for dilation and evacuation in the setting of rupture of membranes of 09/04/221. The patient was consented and received Mifepristone at 2:57AM on 09/05/21. While preparing for laminaria placement patient started to feel abdominal cramping. At 03:30AM while positioning her legs to begin laminaria placement it was noticed that the chuck had bright red blood. At 03:41AM the pregnancy was expelled independently. No evidence of life was observed. The cord was clamped and cut and fetus was placed in a blanket. Misoprostol 400 mcg buccal was then provided and the placenta delivered at 04:28AM. After the placenta delivered the uterus was firm on palpation and no active bleeding was observed. The placenta was found to be intact and subsequently sent to pathology. The fetus was separately sent to pathology after mementos were collected..

 

[kathyvl74]

If it's not an induced AB, then you'd need to code a hospital visit E/M

 

[nielynco]

Hello Coding Community. I will greatly appreciate your advice on coding this type of delivery!
Pt had premature rupture of membrane at 17 weeks. Than Mife. was given to induce the labor. Pt delivered a still born baby.
I cannot code as a Delivery because it's not 20week and looks like a Delivery was induced, should I code as delivery of Placenta 59414 ? It's not an abortion and if it's not a delivery than what is left?.. placenta?
Thank you very much!
G1P0 who presented at 17w4d. She was admitted on 9/4/2021 for dilation and evacuation in the setting of rupture of membranes of 09/04/221. The patient was consented and received Mifepristone at 2:57AM on 09/05/21. While preparing for laminaria placement patient started to feel abdominal cramping. At 03:30AM while positioning her legs to begin laminaria placement it was noticed that the chuck had bright red blood. At 03:41AM the pregnancy was expelled independently. No evidence of life was observed. The cord was clamped and cut and fetus was placed in a blanket. Misoprostol 400 mcg buccal was then provided and the placenta delivered at 04:28AM. After the placenta delivered the uterus was firm on palpation and no active bleeding was observed. The placenta was found to be intact and subsequently sent to pathology. The fetus was separately sent to pathology after mementos were collected..

First and foremost the age of pregnancy determines coding with the help of dissecting the sequence of events that led to the "delivery." In this case, her membranes had ruptured, therefore at 17 weeks, the pregnancy cannot be saved and her body is aborting the fetus - this leads to an inevitable abortion. She is given the mifepristone to induce labor for the inevitable abortion, not to induce the abortion and I assume the Mife was given orally (not a codeable event) as they were then going to insert laminaria. Before they could do that, she went into labor so 59200 would not be an option either. She was then given another oral medication to effect delivery of the placenta. In all, this is the medical management of a spontaneous abortion. Per ICD10, you do not report this as a stillbirth, but rather early fetal demise. due to fetal age. For CPT coding you will report E/M services plus prolonged time which I hope was documented in the chart. As this was not a delivery after 20 weeks, the code 59414 will not apply as well. You can bill initial hospital care and prolonged care for the first day, and subsequent hospital care and then discharge day management for this. ACOG published a paper on termination of pregnancy a few years ago which I have attached for your information.

 

[natashalage]

Dear KathyI74 and Nielynco, Thank you very much for your help and your thorough explanation of this case. Induced labor for the inevitable abortion that was medically managed...= E/M with prolonged time. Got it! Thank you a lot.