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Posted By Lynn Radecky on 07-24-2019, 09:02:31 in Ob-Gyn
I have a patient who at 17weeks had PROM & Chorioamnionitis, she was induced for delivery and delivered vaginally. She then had bleeding and was diagnosed with retained placenta so she had a D&E under ultrasonic guidance that was performed for retained placenta and the patient was then admitted to the ICU for sepsis. Should I bill 59410 for the delivery separating out the antepars to bill? Also, can I bill out for the visits to the ICU to see the patient or would that be included with the 59410 what code do I use for the D&E I was thinking 59160... Thanks!!!
Comments (4)
Posted By Melanie Witt on 07-29-2019, 13:57:07
My bad. The correct number is 575-387-5616
Posted By Melanie Witt on 07-29-2019, 12:54:52
Great. 575-387-5615 is my fax #
Posted By Lynn Radecky on 07-29-2019, 11:28:57
Thanks Melanie for your help. I will be happy to send to you but we do not use scanners in this office. I can fax to you if you want just provide me your fax #.
Posted By Melanie Witt on 07-24-2019, 13:34:42
Lynn, I would appreciate it if you could send me the op note for this case to my email address (nielynco@aol.com). I am doing a presentation for the Ryan Program in October and we are looking for hard cases for early induced abortions and this certainly would qualify (redacted of course for patient name and physician). As to coding, any delivery prior to 20 weeks completed weeks of gestation is an abortion and cannot be coded as a delivery. In this case you have two options: he induced her labor and if he used vaginal suppositories to do so, you would have coded this as 59855. However, she also had retained products and you had to do a D&E so you instead code 59856 ( Induced abortion, by 1 or more vaginal suppositories (eg, prostaglandin) with or without cervical dilation (eg, laminaria), including hospital admission and visits, delivery of fetus and secundines; with dilation and curettage and/or evacuation) and also 76998 for the ultrasonic guidance. Code 59856 has 90 global days so the admission and aftercare in the hospital would be included for recovery from the surgery. However, if the patient was critically ill you may be able to bill critical care after the delivery, but the documentation must clearly denote critical care and only for the complication of the chorioamnionitis. A second option would be report only E/M codes for the delivery (and if he used laminaria to induce you could also code 59200). This means billing for admission at a level matching all the work that day including the delivery if it took place that day, as well as any inpatient visits. For the delivery you might also qualify for prolonged services if time was documented. Then after she had retained products you would code with 59812 for completion of an incomplete abortion which has a 10 day global. Therefore any E/M service billed that day would also require a modifier -25. In checking the RVUs for these codes 59812 has 8.59 RVUs, and 59200 has 1.29 RVUs - compare that to 14.10 RVUs for 59856 which will get you a much higher reimbursement rate assuming the payer does cover 59856 (as the code descriptor sometimes throws them off). Since you had to induce labor, this was not a spontaneous abortion, but rather was an induced abortion despite her PROM so your diagnostic coding will be interesting. Since she had PROM and I assume the onset of labor was within 24 hours of this so the code would be O42.012. For the choriamniomitis you will report O41.122 and with sepsis you also report the code that matches the circumstance (O04.87 for sepsis following induced abortion; O75.3 sepsis during labor: 085 sepsis following delivery) and of course an additional code for severe sepsis (R65.2_) and a code for the infectious agent. What now complicates matters is the gestational age and the fact that despite PROM labor was induced so it implies a termination of pregnancy - in that case you would have to report Z33,2 which includes both an elective and therapeutic termination of pregnancy. If your report this code it is primary and the other codes are secondary. In addition, since there were retained products after the delivery you would also have to report a failed termination code without complications (per ICD 10 guidelines - O07.4). I would really like to present this case also to the AHA Coding Clinic for an opinion on diagnostic coding since it is so complicated and that is another reason I would need the complete op note which hopefully includes the sequence of events.
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