Billing for Interruption of Pregnancy: Early Pregnancy Loss
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)?
Coding rules indicate that an abortion after 20 weeks 0 days is reported using a delivery code. States and payers may have their own policies that should be confirmed prior to submitting a claim.
Possible Procedure Codes and Descriptions
Early Pregnancy Loss/Fetal Demise (In Utero)
MISSED Abortion
| Possible Code | Description |
|---|---|
|
59820 |
Before 14 weeks |
|
59821 |
14 weeks to 20 weeks |
Induced Abortion
PROCEDURAL 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 |
Medical Abortion
| Possible Code | Description |
|---|---|
|
59850-59852 |
Injections before 20 weeks |
|
59855-59857 |
By suppositories before 20 weeks |
|
S0199- |
Medication Abortion-Oral: Medically induced abortion by oral ingestion of medication including all associated services and supplies (e.g., patient counseling, office visits, confirmation of pregnancy by hcg, ultrasound to confirm duration of pregnancy, ultrasound to confirm completion of abortion) except drugs. HCPCS code S0199 is generally considered "all-inclusive," except for the medications. |
|
S0190- |
Mifepristone, oral, 200 mg Sometimes health plans instruct the use of the appropriate Evaluation & Management (E/M) code (99202-99215) along with S0190 |
|
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 |
|---|---|
|
59812 |
Before 20 weeks 0 days |
|
Delivery code |
After 20 weeks 0 days or more |
Additional Resources
This information is designed as an educational resource to aid clinicians when providing obstetric and gynecologic care and for information purposes only. The use of this information is voluntary and clinicians should be familiar with and comply with local restrictions on abortion, including medication abortion. This response is not intended to be used as a substitute for your independent judgment. This response is not medical advice and should not be considered as inclusive of all proper treatments or methods of care or as a statement of the standard of care. If this response includes coding information, please note that proper coding may require analysis of statutes, regulations or carrier policies and, as a result, the proper code result may vary from one payer to another. Additionally, this response is provided “as is” without any warranty of accuracy, reliability or otherwise, either express or implied. ACOG Foundation, the American College of Obstetricians and Gynecologists, and their officers, directors, members, employees, and agents, will not be liable for any loss, damage, or claim with respect to any liabilities, including direct, special, indirect, or consequential damages, incurred in connection with the Resource Center or this response.