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)?
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 |
|---|---|
|
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 |
|
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 |