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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.
  • Surgical abortion: The removal of products of conception through a surgical procedure.
  • 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.

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., surgical or medical)
  • Which specific procedure was performed (e.g., D&C, D&E, injections surgical 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)

Surgical Abortion
Possible Code Description

59820

Before 14 weeks

59821

14 weeks to 20 weeks


Medical Abortion
Possible Code Description

59850-59852

Injections before 20 weeks

59855-59857

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


Induced Termination

Surgical Abortion
Possible Code Description

59840

By D&C any trimester

59841

By D&E 14 weeks to 20 weeks

59841-22

20 weeks or more


Non-Surgical Abortion
Possible Code Description

59850-59852

Injections before 20 weeks

59855-58857

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

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

59812

Before 20 weeks 0 days

Delivery code

After 20 weeks 0 days or more


Payer Resources

Private payers continue to update their policies surrounding this matter. Please be sure to visit the payer’s website for the most updated policy changes in relation to billing and coding for miscarriages.