Wiki Termination of pregnancy, Inpatient, by KCI injection and Delivery.

[natashalage]

Hello Coding Community! I will greatly appreciate your expertise in the following case since I am still learning and struggling between 2 coding options.

12/12- pt was admitted for complication of pregnancy, 25 weeks.

12/13-The decision was made to terminate the pregnancy with fetal intracardiac KCI injection . After the procedure, confirmed intrauterine fetal demise.

12/14- Induction of labor began with misoprostol and she delivered a stillbirth baby.

There are 2 options how to code it (I think):

Option 1: 59850-Induced abortion, by 1 or more intra-amniotic injections (amniocentesis-injections), including hospital admission and visits, delivery of fetus and secundines;

Option 2: 59897-unlisted fetal invasive procedure like 59866-multiple pregnancy reduction AND 59409-delivery (since 25w)

After reviewing what KCI and intra-amniotic injections are, I made a conclusion that 59850 is not the right code because KCI is potassium chloride injected into heart of the fetus. While 59850 is a hypertonic solution via drip via amniocentesis. KCI is used in 59866- multiple preg reduction; however, it's for Reduction leaving one viable fetus alive. In our case the main objective was to completely terminate the pregnancy. I am thinking to code is as unlisted 59897 with like code 59866-reduction and then the Delivery= Option 2.
I will greatly appreciate you help! Thank you.

 

[nielynco]

Hello Coding Community! I will greatly appreciate your expertise in the following case since I am still learning and struggling between 2 coding options.

12/12- pt was admitted for complication of pregnancy, 25 weeks.

12/13-The decision was made to terminate the pregnancy with fetal intracardiac KCI injection . After the procedure, confirmed intrauterine fetal demise.

12/14- Induction of labor began with misoprostol and she delivered a stillbirth baby.

There are 2 options how to code it (I think):

Option 1: 59850-Induced abortion, by 1 or more intra-amniotic injections (amniocentesis-injections), including hospital admission and visits, delivery of fetus and secundines;

Option 2: 59897-unlisted fetal invasive procedure like 59866-multiple pregnancy reduction AND 59409-delivery (since 25w)

After reviewing what KCI and intra-amniotic injections are, I made a conclusion that 59850 is not the right code because KCI is potassium chloride injected into heart of the fetus. While 59850 is a hypertonic solution via drip via amniocentesis. KCI is used in 59866- multiple preg reduction; however, it's for Reduction leaving one viable fetus alive. In our case the main objective was to completely terminate the pregnancy. I am thinking to code is as unlisted 59897 with like code 59866-reduction and then the Delivery= Option 2.
I will greatly appreciate you help! Thank you.

Your thinking is sound on this one. You should bill the delivery code, but 59409 may not be the correct code is your provider has been the one caring for the patient for her full pregnancy and will be taking care of her following the termination. In that case look at the 59410-52 code (for reduced services) which takes care of any prenatal, induction and post delivery care in both the hospital and outpatient. But of note, 59409 would also include the induction method used. The fetal intracardiac injection can only be reported using 59897 and I would compare the work to 59866. You might be able to make the case for billing the initial hospital care as the admission was for a complication of pregnancy, not initially for delivery.

 

[nielynco]

Your thinking is sound on this one. You should bill the delivery code, but 59409 may not be the correct code is your provider has been the one caring for the patient for her full pregnancy and will be taking care of her following the termination. In that case look at the 59410-52 code (for reduced services) which takes care of any prenatal, induction and post delivery care in both the hospital and outpatient. But of note, 59409 would also include the induction method used. The fetal intracardiac injection can only be reported using 59897 and I would compare the work to 59866. You might be able to make the case for billing the initial hospital care as the admission was for a complication of pregnancy, not initially for delivery.

Correct, I meant 59400-52, not 59410-52 if you provided all of her care.

 

[dbolivar1]

Hello,

Hope it was okay to add here. I have denial on CPT 59897 and HCPCS J1160 with DX O35.0XX0 and Z3A.31. Its needing another dx, I'm not sure what other dx to use. May I get some help?

Patient was 31wks pregnant and decided to terminate pregnancy due to fetal anomaly. This would be a two day procedure. The 59897 and J1160 was done on day 1 preparation for IOL. I'm not familiar with this codes, I have not seen this before.

COUNSELING:
We discussed pregnancy options which include continuation of the pregnancy with parenthood or adoption, and termination of pregnancy. The patient plans to proceed with termination of pregnancy after considering her options as the pregnancy will have a profound negative impact upon her physical or mental health. We discussed use of mifepristone for cervical ripening and feticide. Amya and her partner understood the need for feticide and took extensive counseling re intra-fetal dig vs. intracardiac KCL tomorrow or Monday. Ultimately, she decided on intrafetal dig today, mifepristone. Called L&D for IOL slot tomorrow AM.


Medications
Mifepristone 200 mg PO

Intrafetal digoxin
Appropriate timeout confirmed correct patient and procedure. Amya was placed in the supine position and ultrasound showed anterior placenta, vertex presentation. Under ultrasound guidance and just to the right of the umbilicus, which was prepped with chloraprep, a 3.5 inch 22 gauge spinal needle was passed through skin uterus and placenta into the anterior fetal body. 1 mg of digoxin was injected through the spinal needle. The needle was removed and a bandaid placed. The patient tolerated the procedure well.

 

[nielynco]

I have done presentations with physicians for the Ryan Program in the past and we are agreed that coding for the intrafetal cardiac injection would be correctly coded with

• Separate billing for the intrafetal injection of digoxin with 59897
• J code for Digoxin
• Diagnostic linkage is Z33.2

If you try and use the O35 code it would have to be primary and that would then bounce as to a reason for giving the Digoxin which was for the sole purpose of making sure the fetus was not born alive. Compounding this now of course is political expectations. You may have to handle this with a letter to the payer explaining the circumstances.

 

[dbolivar1]

I have done presentations with physicians for the Ryan Program in the past and we are agreed that coding for the intrafetal cardiac injection would be correctly coded with

• Separate billing for the intrafetal injection of digoxin with 59897
• J code for Digoxin
• Diagnostic linkage is Z33.2

If you try and use the O35 code it would have to be primary and that would then bounce as to a reason for giving the Digoxin which was for the sole purpose of making sure the fetus was not born alive. Compounding this now of course is political expectations. You may have to handle this with a letter to the payer explaining the circumstances.

Thank you this is helpful.