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Posted By Lillian on 06-20-2018, 12:13:10 in Ob-Gyn
The patient's was 22wks based on LMP but 19wks based on ultrasound. She had a spontaneous Vaginal Delivery with Manual Placenta extraction due to IUFD.
Do I code based on LMP for a delivery OR based on the ultrasound for the E/M and Placenta Delivery?

Thank you.
Comments (1)
Posted By Melanie Witt on 06-20-2018, 12:42:59
This is tough one to answer. In general a fetus born between 20-37 weeks gestation is considered a preterm birth and anything younger would be classified as a spontaneous abortion. You will need to consult with the physician as to the correct date for this case. If the fetus died in utero prior to 20 weeks, it will not get any larger so the ultrasound would date the pregnancy as less, but if there was early fetal death and this was in any way induced it could be construed as the medical management of a missed abortion and the delivery codes would not apply. Again, you need to have a talk with the provider to determine the best course of action. If this could be considered a delivery rather than surgical treatment for an incomplete spontaneous abortion, then you bill the delivery code (if billing delivery only) or if billing globally apply a modifier -52 to the global code for reduced services (fewer antepartum visits for instance).
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