Microsoft powerpoint - interrupted pregnancy coding_final

Terry Tropin, RHIA, CPC, CCS-P, ACS-OB, PCS Content Development Expert, DecisionHealth ACOG Committee on Coding and
Nomenclature
“Interrupted Pregnancy Coding”
CONFLICT OF INTEREST DISCLOSURE:
FACULTY
• NO DISCLOSURES TO DECLARE
Terry Tropin, RHIA, CPC, CCS-P, ACS-OB, PCS • The American College of Obstetricians and Gynecologists (ACOG) is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide medical education for physicians.
• The American College of Obstetricians and Gynecologists (ACOG) designates this educational activity for a maximum of 2 AMA PRA Category 1 Credits™ or up to a maximum of 2 Category 1 ACOG Cognate Credits. Physicians should only claim credit commensurate with the extent of their participation in the activity. • At the beginning of the program, faculty members are expected to disclose any such information to participants. Such disclosure allows you to evaluate better the objectivity of the information presented in lectures. Please report on your evaluation form any undisclosed conflict of interest you perceive. Thank you! • Inclusion of any product, procedure, or method of practice in this program does not constitute endorsement by ACOG. – Define terms for abnormal products of conception (Hydatidiform mole, molar pregnancy, blighted ovum) – Define abortion procedure codes (missed, – Report an abortion performed using injections – Link each diagnosis to the appropriate – Report a medical (nonsurgical) abortion – Understand which services may be reported • Definition: The cells from the fertilized egg multiply abnormally, resulting in a mass of cells resembling a cluster of grapes. • Diagnosis code: 630 Hydatidiform mole • Uterine evacuation and curettage for – Evacuation of uterine cavity, any method – Administration of intravenous oxytocin – Injection of prostaglandin into the myometrium • Other services that also can be reported – Transvaginal or transabdominal ultrasound – Insertion of cervical dilator by physician (59200) • Visit when condition diagnosed (modifier 57) • Note: Post-op visits for 90 days following this • Hysterotomy, abdominal (eg, for hydatidiform • Other services that also can be reported – Transvaginal or transabdominal ultrasound • Visit when condition diagnosed (modifier 57) • Note: Post-op visits for 90 days following – Abnormal growth of cells develops from products of – The fertilized egg develops a placenta and membrane • Diagnosis code: 631 Other abnormal product
of conception
• Uterine curettage to scrape sides of uterus • Other services that also can be reported – Transvaginal or transabdominal ultrasound– Administration of paracervical block (64435)– Insertion of cervical dilator by physician • Antepartum care• Visit when condition diagnosed (modifier 57) • Note: Post-op visits for 10 days following • Definition: An empty gestational sac, blighted ovum or a fetus or fetal pole with a heartbeat prior to completion of 20 weeks 0 days gestation.
• If beyond this period of time, use “missed • “…not following spontaneous or induced – First Trimester – First day of last menstrual period (day 0) to less than 14 weeks (13 weeks 6 days) – Second trimester – 14 weeks 0 days to 28 • Some state legislatures legally define the difference between a miscarriage (spontaneous abortion) and a stillbirth (baby not born alive) by either: • This legal definition may determine which • Treatment of missed abortion, completed surgically; first trimester
– Serial dilation of cervix with mechanical dilators – Emptying uterine cavity of products of conception using – Administration of intravenous oxytocin • Other services that also can be reported – Transvaginal or transabdominal ultrasound– Administration of paracervical block (64435)– Insertion of cervical dilator by physician (59200)– E/M service if appropriate • Antepartum care• Visit when condition diagnosed (modifier 57) • Note: Post-op visits for 90 days following this • Treatment of missed abortion, completed surgically; second trimester
– Transcervical approach– Sounding of uterus for size– Serial dilation of cervix with mechanical dilators– Emptying uterine cavity of products of conception using • Suction apparatus OR• Sharp curette – Administration of intravenous oxytocin
– Reconstruction of fetal and placental parts as much
as possible to ensure all products of conception
have been removed
– Removal of instruments– Repair of cervical incision • Other services that also can be reported – Transvaginal or transabdominal ultrasound – Administration of paracervical block (64435) – Ultrasound guidance (76998)
– Insertion of cervical dilator by physician (59200) • Visit when condition diagnosed (modifier 57) • Note: Post-op visits for 90 days following • Definition: fertilized egg implants outside • Fifth digit indicates whether or there is also – 633.X0 without intrauterine pregnancy • Codes vary by location of ectopic tissue • Ovarian and tubal codes vary by whether • Interstitial codes vary by whether or not all – Abdominal or vaginal approach– Evacuation of hemoperitoneum– Removal of ectopic tissue, any • Other services that also can be reported – Transvaginal or transabdominal ultrasound– Diagnostic laparoscopy (49320)– D&C to see if also intrauterine pregnancy • 58120 (no intrauterine pregnancy) • 59812 (intrauterine pregnancy) – Tubal reconstructive surgery (opposite side)– Administration of paracervical block (64435)– E/M services as appropriate • Antepartum care• Visit to diagnose ectopic pregnancy (57 modifier) • Note: Post-op visits for 90 days following this – Abdominal incision– Evacuation of hemoperitoneum– Isolation and resection of ectopic pregnancy, – Delivery of fetus– Delivery of placenta. May also be left in situ • Other services that also can be reported – Transvaginal or transabdominal ultrasound– Diagnostic laparoscopy (49320)– D&C to see if also intrauterine pregnancy • 58120 (no intrauterine pregnancy) • 59812 (intrauterine pregnancy) • Antepartum care• Visit when condition diagnosed (modifier 57) • Note: Post-op visits for 90 days following POC implant in the uterine portion of the fallopian tubes, lateral to the round ligament. • Total hysterectomy (removal of corpus
• May or may not also remove the tubes and • Partial hysterectomy (removal of cornual
region of the uterus containing the interstitial pregnancy) • Reattachment of round ligament which
connects tube to uterus
• Other services that also can be reported – Transvaginal or transabdominal ultrasound– Diagnostic laparoscopy (49320)– D&C to see if also intrauterine pregnancy • 58120 (no intrauterine pregnancy) • 59812 (intrauterine pregnancy) – Tubal reconstructive surgery (opposite side)– E/M service if appropriate • Antepartum care• Visit when condition diagnosed (modifier 57) • Note: Post-op visits for 90 days following this • Other services that also be reported – Transvaginal or transabdominal ultrasound– Cerclage to prevent hemorrhage may be performed prior – D&C to see if also intrauterine pregnancy • 58120 (no intrauterine pregnancy) • 59812 (intrauterine pregnancy) – Trachelectomy 57530– E/M service if appropriate • Antepartum care• Visit when condition diagnosed (modifier 57) • Note: follow-up visits for 90 days following this • If procedure performed laparoscopically, a • Laparoscopy codes do not designate site • Laparoscopic creation of pneumoperitoneum • Excision and removal of ectopic pregnancy • Laparoscopic creation of pneumoperitoneum • Excision and removal of ectopic pregnancy • Salpingectomy and/or oophorectomy
• Other services that also can be reported – Transvaginal or transabdominal ultrasound – D&C to see if also intrauterine pregnancy • Visit when condition diagnosed (modifier 57) • Note: post-op visits for 90 days following this • Different diagnoses depending on whether – Listed in table after section heading in ICD-9- – Describe complications associated with the – .0 Genital tract and pelvic infection – .2 Damage to pelvic organs and tissues • Digits listed under each 3-digit headings • 0 - Unspecified (documentation does not • 1 - Incomplete (all POC have not been • 2 - Complete (all POC had been completely • Definition: POC are expelled without surgical or medical intervention. Also called miscarriage.
• Procedure reported with diagnosis code 634.X2 – Prior to 20 weeks 0 days gestational age – E/M codes – After 20 weeks 0 days gestational age – Delivery code • Procedure reported with diagnosis code 634.X1 – Prior to 20 weeks 0 days gestational age – 59812 – After 20 weeks 0 days gestational age – Delivery code • Fourth digit X in diagnosis code indicates • Serial dilation of cervix with mechanical • Emptying uterine cavity of POC using: • Administration of intravenous oxytocin • Other services that also can be reported – Transvaginal or transabdominal ultrasound– Administration of paracervical block (64435)– Insertion of cervical dilator (59200)– D&C to see if also intrauterine pregnancy • 58120 (no intrauterine pregnancy) • 59812 (intrauterine pregnancy) • Antepartum care• Visit when condition diagnosed (modifier 57) • Note: post-op visits for 90 days following this • Definition: Infection of POC, membranes – Use fourth digit 0 (genital tract and pelvic • 658.43 (infection of amniotic cavity) • 646.63 (infection of genitourinary tract in pregnancy) • Administration of intravenous antibiotics prior to • Serial dilation of cervix with mechanical dilators • Emptying uterine cavity of POC using: • Administration of intravenous oxytocin • S2260 (17 to 24 weeks, any surgical method) • S2262 (25 weeks or greater, for maternal indication) • S2265 (25-28 weeks, for fetal indication) • S2266 (29-31 weeks, for fetal indication) • S2267 (32 weeks or greater, for fetal indication) • Sometimes codes from Pregnancy chapter • Provides information on conditions that led to decision to perform abortion, for example • 647.53 Rubella in mother• 648.33 Drug dependence in mother • 655.03 Anencephaly• 655.13 Chromosomal abnormality in fetus surgical or medical intervention by physician. Also called therapeutic or elective abortion.
• Diagnosis code: 635 (5 digits required) • Procedure codes: surgical (D&C or D&E) – Sounding of uterus for size– Serial dilation of cervix with mechanical – Emptying uterine cavity of the products of • Suction apparatus OR• Sharp curette – Administration of intravenous oxytocin– Removal of surgical instruments – Serial dilation of cervix with mechanical dilators – Emptying uterine cavity of the products of conception – Reconstruction of fetal and placental parts as
much as possible to ensure all POC have been
removed
– Administration of intravenous oxytocin – 14 weeks 0 days to 20 weeks 0 days 59841 • Modifier 22 used to indicate the increased procedural services (physician work) involved when the gestational period is 20 weeks or more • Other services that also can be reported – Transvaginal or transabdominal ultrasound – Administration of paracervical block (64435) – Insertion of cervical dilator (59200) • Visit when condition diagnosed (modifier 57) • Note: post-op visits for 10 days following this • Hospital visits before and after procedure • Injections into amniotic sac around fetus • Delivery of secundines, which includes: • 59851 – Dilation and curettage and/or • 59852 – Procedure has failed; abdominal and uterine incision necessary to remove fetus and secundines (hysterotomy) • Other services that also can be reported – Transvaginal or transabdominal ultrasound – Insertion of cervical dilator by physician • Visit when condition diagnosed (modifier 57) • Note: follow-up visits for 90 days following • Other services that also can be reported – Transvaginal or transabdominal ultrasound– Insertion of cervical dilator by physician – Dilation and curettage (58120)
– E/M service if appropriate
• Antepartum care• Visit when condition diagnosed (modifier 57) • Note: post-op visits for 90 days following • Hospital admission• Hospital visits• Transcervical approach• Sounding of uterus for size• May include insertion of laminaria to dilate cervix• Suppositories inserted into vaginal canal to • Delivery of fetus• Delivery of secundines – Placenta– Umbilical cord– Membranes • 59856 - Dilation and curettage and/or • 59857– Procedure has failed; abdominal and uterine incision necessary to remove fetus and secundines (hysterotomy) • Other services that also can be reported – Transvaginal or transabdominal ultrasound • Visit when condition diagnosed (modifier 57) • Note: post-op visits for 90 days following • Other services that also can be reported – Transvaginal or transabdominal ultrasound – Dilation and curettage (58120)
• Visit when condition diagnosed (modifier 57) • Note: post-op visits for 90 days following • Mifepristone (Mifeprex) and Misoprostol – No global code to report this service – Visits, drugs, ultrasound reported separately • Danco Laboratories - Only company in the US that is authorized to manufacture, market and distribute these drugs – Established requirements for physicians – Provides Medication Guidelines – Provides Patient Agreement – www.fda.gov/cder/drug/infopage/mifepristone/ – Must provide patient with Medication Guide– Must have patient sign Patient Agreement– If medical treatment is unsuccessful, must – Must report any complications that result from – Must record medication’s serial number in • Some states have additional requirements – 24 hour waiting period before first tablets – Four visits may be required rather than 3 • Provide Medication Guide – how the drug works and what to expect during treatment • Secure Patient Agreement – Sign form agreeing to treatment and agreeing to come for 2 additional visits • Perform ultrasound examination to date – Patient must be less than 7 weeks pregnant – Up to 49 days after beginning of her last • Dispensing the medication (Mifepristone prescription for these tablets. Must be given by the physician to patient in the office.
– 76815 – limited ultrasound exam OR– 76817 – transvaginal ultrasound exam – E/M code based on typical time listed – 99070 (CPT’s general supply code) OR – J8499 (Prescription drug, oral, non- • S0199 Medically induced abortion by oral ingestion of medication including all associated services and supplies (except drug). Includes: • Ultrasound to confirm duration of pregnancy • Ultrasound to confirm completion of abortion – S0190 Mifepristone, oral, 200 mg (Mifeprex) • Counseling and/or examining the patient • Dispensing the medication (Misoprostol) • Physician may also give medications to treat symptoms such as nausea or diarrhea • E/M established patient code using typical – 99070 (CPT’s general supply code) OR Coding for Second Visit Using HCPCS S Codes • S0199 Medically induced abortion by oral – S0191 Misoprostol, oral, 200 mcg.
• E/M service to confirm that pregnancy has • If pregnancy has not been terminated, then it may be necessary to see the patient for another visit to provide a surgical abortion (59840, D&C) • E/M established patient visit based on – Examination to establish whether pregnancy – Methotrexate (a cancer drug) and Misoprostol – Instead of Mifepristone and Misoprostol • This is also reported using codes for E/M services, ultrasounds, and the medications • Abortion has been legal in the United • These illegally induced abortion codes are • Retained products of conception following abortion that was performed during previous encounter – Surgical treatment of incomplete abortion • Definition: An abortion was attempted, but the patient remained pregnant at the end of the encounter • Diagnosis 638 – Four digits required• Procedure: An abortion code, depending on – Modifier 52 (reduced services) if another procedure was performed during the session – Modifier 53 (discontinued services) no other procedure is performed during the session – Successful abortion during previous visit; – Successful abortion during this visit; but patient has developed a complication. There is no way to code the specific complication.
• Successful abortion during previous visit; • Visit 1 – report appropriate abortion code • Visit 2 – report code from 639 series • 630 (hydatidiform mole) has only 3 digits; no 4th digit available to report complications • Example: patient is treated for hydatidiform mole and suffers renal failure (same encounter) – no 4th digit available to report complications • Example: patient is treated for blighted ovum – 631 (other abnormal products of conception) – 639.2 (complication, damage to pelvic organs or • Code 633 (ectopic pregnancy) – 5 digits – 4th digit for location of ectopic tissue – 5th digit indicates whether or not intra- • Example: patient is treated for tubal pregnancy but suffers excessive hemorrhage (same visit) – 633.10 (tubal pregnancy)– 639.1 (hemorrhage) – Whether abortion was spontaneous, induced, – If any other diagnoses from the pregnancy • It is important to link the correct diagnosis • Don’t forget other services that may be • Use ACOG’s coding reference materials to: – Appeal denied claims– Enhance coding knowledge in Ob/Gyn– Develop internal coding policies– Dispute insurance company policies • Ob/Gyn CPT Coding Manual with CD Rom• ICD-9-CM “Abridged” Diagnostic Coding in OB/Gyn• Frequently Asked Questions in Ob/Gyn Coding • Essential Guide to Coding in Ob/Gyn • To order visit www.acog.org/bookstore or call • ACOG Coding Workshops
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