Key Terminology for Billing

The following terms are as defined by ACOG clinical practice and coding policies:

  • Early pregnancy loss:A nonviable, intrauterine pregnancy with either an empty gestational sac or a gestational sac containing an embryo or fetus without fetal heart activity within the first 12 6/7 weeks of gestation 1. In the first trimester, the terms miscarriage, spontaneous abortion, and early pregnancy loss are used interchangeably, and there is no consensus on terminology in the literature.
  • Missed abortion: An empty gestational sac, blighted ovum, or a fetus or fetal pole without a heartbeat prior to completion of 20 weeks 0 days gestation.
  • Incomplete abortion: The expulsion of some products of conception with the remainder evacuated surgically.
  • Medical abortion: The removal of products of conception through prescribed pharmaceutical intervention.
  • Septic abortion: The withdraw of the products of contraception complicated by a uterine infection.

Defining Trimesters

The following Trimesters are as defined by ACOG and ICD-10 coding guidelines.

Trimester ACOG Definition ICD-10 Definition
First trimester First day of last menstrual period (day 0) up to and including 13 weeks 6 days Less than 14 weeks 0 days
Second trimester 14 weeks 0 days up to and including 27 weeks 6 days 14 weeks 0 days to less than 28 weeks 0 days
Third trimester 28 weeks or more 28 weeks 0 days to delivery

Coding for Early Pregnancy Loss

Correct diagnostic and procedural coding in cases of interruption of pregnancy and stillbirth depends on the following:

  • Why the procedure was performed (e.g., missed or incomplete, pregnancy complicated by some condition of the mother or the fetus)
  • When during the pregnancy the procedure was performed (e.g., gestational age)
  • How the procedure was performed (e.g., medical/procedural)
  • Which specific procedure was performed (e.g., D&C, D&E, injections procedural treatment of incomplete or septic abortion)?

ACOG’s Committee on Health Economics and Coding recommends that an abortion after 20 weeks 0 days is reported using a delivery code. However, some state legislatures have legally defined the difference between a miscarriage and a stillbirth by the number of weeks or by gram weight. This legal definition may determine which CPT codes are selected: abortion (59812-59857) or delivery (59400-59515).

Possible Procedure Codes and Descriptions

Early Pregnancy Loss/Fetal Demise (In Utero)

MISSED Abortion
Possible Code Description


Before 14 weeks


14 weeks to 20 weeks

Induced Abortion

Possible Code Description


By D&C any trimester


By D&E 14 weeks to 20 weeks


20 weeks or more

Medical Abortion
Possible Code Description


Injections before 20 weeks


By suppositories before 20 weeks

E/M Code

Spontaneous/Other Medical Abortion before 20 weeks

E/M Code + 59414

Spontaneous + delivery of placenta before 20 weeks

Delivery Code

On or after 20 weeks

Complete (Spontaneous) Abortion

Possible Code Description

E/M Code

Before 20 weeks 0 days

Delivery Code

After 20 weeks 0 days

Incomplete (Spontaneous) Abortion

Possible Code Description


Before 20 weeks 0 days

Delivery code

After 20 weeks 0 days or more