Wiki suction D&C

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Korbc

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hello
doesn't anyone know a code i could use for suction d&c NOT for missed abortion. It looks like they are all for missed abortion. She succefully delivered and then weeks later essentialy needed a hematoma suctioned out....would I still use one of the threatened abortion codes anyway? The doctor submitted it with 58562 which is hysteroscopy with foreign body removal, but I wouldn't consider her own blood to qualify being a FB. Also, in the title of the op she does have "suction d&C"
this is a brief description
Cervix was identified. Tenaculum was placed at 12 o'clock. A 5 mL of local was placed both at 3 and 9 o'clock. She has a tiny pinpoint cervix. It was gently dilated up to 31. The suction curette was then placed into the cavity. Suction was performed for moderate tissue. Then, the suction was removed. A gentle D and C was then performed. Suction one more pass for no further tissue. Instruments were removed

Thanks!
 
So from this description it does not appear a hysteroscope was used at all. If she "delivered" this would be classified as a PP curettage - 59160. A missed abortion happens when a non-viable fetus dies in the uterus prior to 20 completed weeks but has not been expelled so the surgeon goes in and removes is surgically - that is not the same thing as a D&C. The patient could have had fetal demise, but then expelled the contents on her own (without surgical intervention) but then suffered a complication of hematoma following that. From an ICD10 diagnostic perspective you would consider this to be an incomplete abortion (see the ICD10 guidelines for the explanation of how to code) and if they then had to do the D&C 4 week after she aborted and there was no products of conception found, you can use 58120. If they did find products of conception you should instead report 59812. You might want to reference the attached document which was prepared by ACOG to deal with termination of pregnancy coding issues.
 

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  • ACOG Terminations - Abortion Coding.pdf
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Thank you so much. This threw me off because the baby was full term and alive and well for delivery so none of those incomplete or missed abortion for suction d&c applied, but in the note she did say she felt it was remaining products of conception. And then for the post partum curretage it just didn't seem to include the work of the suction? I know she then says gentle D&C was performed after the suction, so would you used the 59160 with a 22?
 
nielynco said:
So from this description it does not appear a hysteroscope was used at all. If she "delivered" this would be classified as a PP curettage - 59160. A missed abortion happens when a non-viable fetus dies in the uterus prior to 20 completed weeks but has not been expelled so the surgeon goes in and removes is surgically - that is not the same thing as a D&C. The patient could have had fetal demise, but then expelled the contents on her own (without surgical intervention) but then suffered a complication of hematoma following that. From an ICD10 diagnostic perspective you would consider this to be an incomplete abortion (see the ICD10 guidelines for the explanation of how to code) and if they then had to do the D&C 4 week after she aborted and there was no products of conception found, you can use 58120. If they did find products of conception you should instead report 59812. You might want to reference the attached document which was prepared by ACOG to deal with termination of pregnancy coding issues.
Click to expand...
also i know it says in 59160 that banjo is preferrable, so if suction was used for the pp curettage could i code i still code it with 59160 do you think?
 
nielynco said:
So from this description it does not appear a hysteroscope was used at all. If she "delivered" this would be classified as a PP curettage - 59160. A missed abortion happens when a non-viable fetus dies in the uterus prior to 20 completed weeks but has not been expelled so the surgeon goes in and removes is surgically - that is not the same thing as a D&C. The patient could have had fetal demise, but then expelled the contents on her own (without surgical intervention) but then suffered a complication of hematoma following that. From an ICD10 diagnostic perspective you would consider this to be an incomplete abortion (see the ICD10 guidelines for the explanation of how to code) and if they then had to do the D&C 4 week after she aborted and there was no products of conception found, you can use 58120. If they did find products of conception you should instead report 59812. You might want to reference the attached document which was prepared by ACOG to deal with termination of pregnancy coding issues.
Click to expand...
also i the cervix was dilated and 59160 doesn't include dilation, i find this one so tricky because there are only codes that include components of what was done or the use of hyesteroscope is missing from removal of foreign body in uterus, then no sucton d&c after a healthy live born infant....i was almost going to just go with unlisted procedure....
 
You are overthinking this. PP curettage can be performed in any way that the provider feels is appropriate. The determining factor is whether she has delivered and the lining of the uterus requires removal of debris whether that be blood clots or placental tissue. The cervix is not always dilated when this procedure is performed - it depends on how long after the birth it is needed. So whether they dilate of not, it is still a PP curettage. IF a hysteroscope is used during a PP curettage (which would be rare) you would bill a diagnostic hysteroscopy with the curettage code as long as the physician documents findings in using the hysteroscopy. Documentation is everything in these cases.
 
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