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.
- 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.