Billing for Interruption of Pregnancy: Early Pregnancy Loss

Before diving into clinical approaches or coding guidance, clarifying the terminology used in early pregnancy care is important. The following definitions align with ACOG’s clinical practice and coding standards:

• Early pregnancy loss: A nonviable, intrauterine pregnancy within the first 12 6/7 weeks, with either an empty sac or a sac containing an embryo or fetus without cardiac activity. Also referred to as miscarriage or spontaneous abortion.
• Missed abortion: An empty gestational sac or non-viable fetus identified before 20 weeks, without expulsion of the tissue.
• Incomplete abortion: Partial expulsion of products of conception, typically requiring surgical intervention.
• Medical abortion: Pharmacologic removal of pregnancy tissue.
• Septic abortion: Abortion complicated by uterine infection.

Trimesters in Pregnancy: ACOG and ICD-10 Perspectives

Pregnancy is commonly divided into three trimesters, and while the general timeframes are widely accepted, both ACOG (American College of Obstetricians and Gynecologists) and ICD-10 coding guidelines offer specific definitions that are important for clinical and documentation purposes.

As outlined by ACOG and ICD-10 Coding Guidelines:

First Trimester

• ACOG Definition: Begins on the first day of the last menstrual period (day 0) and continues up to and including 13 weeks and 6 days of gestation.
• ICD-10 Definition: Less than 14 weeks 0 days.

Second Trimester

• ACOG Definition: Spans from 14 weeks 0 days to 27 weeks and 6 days.
• ICD-10 Definition: From 14 weeks 0 days to less than 28 weeks 0 days.

Third Trimester

• ACOG Definition: Begins at 28 weeks 0 days and continues until delivery.
• ICD-10 Definition: 28 weeks 0 days through the end of pregnancy.

Coding for Early Pregnancy Loss: Key Considerations

When coding for early pregnancy loss, it is essential to use accurate diagnostic and procedural codes, based on the following key factors:

• Reason for the Procedure: The nature of pregnancy loss determines the code. For example, whether it was a missed abortion, incomplete abortion, or caused by maternal or fetal complications.
• Gestational Age: The stage of pregnancy at which the Procedure occurred plays a vital role in determining the correct code. Accurate coding will reflect the timing of the loss.
• Method of Procedure: The Procedure used to manage the pregnancy loss, such as medical intervention or surgical procedures (e.g., D&C, D&E), should be coded correctly.
• Specific Procedure Performed: The type of intervention, whether it be a surgical procedure or an injection for treatment of incomplete or septic abortion, will affect the coding choice.

It's important to note that abortions performed after 20 weeks 0 days should be coded using delivery codes.

Additionally, state and payer-specific policies must be reviewed, as they may have unique requirements or variations for billing and coding.

Possible Procedure Codes and Descriptions For Early Pregnancy Loss

The following procedure codes and descriptions are commonly used to report various types of pregnancy loss, depending on the method of intervention and gestational age at the time of the procedure.

Early Pregnancy Loss/Fetal Demise (In Utero)

Missed Abortion

• Code 59820: Used for a missed abortion before 14 weeks of gestation.
• Code 59821: Used for a missed abortion between 14 weeks and 20 weeks of gestation.

Induced Abortion/Procedural Abortion

By D&C (Dilation and Curettage)

• Code 59840: Used for induced abortion by D&C at any trimester.

By D&E (Dilation and Evacuation)

• Code 59841: Used for induced abortion by D&E between 14 weeks and 20 weeks of gestation.
• Code 59841-22: Used for induced abortion by D&E after 20 weeks of gestation.

Medical Abortion

Injections Before 20 Weeks

• Code 59850-59852: Used for medical abortion through injections before 20 weeks of gestation.

By Suppositories Before 20 Weeks

• Code 59855-59857: Used for medical abortion through suppositories before 20 weeks of gestation.

Medication Abortion-Oral

• Code S0199: Used for medically induced abortion by oral ingestion of medication, including all associated services and supplies (patient counseling, office visits, pregnancy confirmation via hCG, ultrasound for duration and completion of pregnancy). This code is considered "all-inclusive" except for the medications.

Mifepristone (Oral, 200 mg)

• Code S0190: Used for Mifepristone oral medication (200 mg) as part of a medical abortion.

E/M Code for Medical Abortion (Spontaneous or Other Medical Abortion before 20 Weeks)

• Code 99202-99215: Used for Evaluation & Management services in conjunction with medical abortion before 20 weeks.

Spontaneous + Delivery of Placenta Before 20 Weeks

• Code 59414: Used for spontaneous abortion with delivery of the placenta before 20 weeks of gestation.

Delivery Code On or After 20 Weeks

• Code for Delivery: Used for delivery in cases of abortion or miscarriage after 20 weeks.

Complete (Spontaneous) Abortion

Before 20 Weeks 0 Days

• E/M Code: Used for Evaluation & Management services related to spontaneous abortion before 20 weeks of gestation.

After 20 Weeks 0 Days

• Delivery Code: Used for delivery-related services after 20 weeks of gestation in the case of spontaneous abortion or fetal demise.

Incomplete (Spontaneous) Abortion

Before 20 Weeks 0 Days

• Code 59812: Used for incomplete spontaneous abortion procedures before 20 weeks of gestation.

After 20 Weeks 0 Days or More

• Delivery Code: Used for delivery-related services when the abortion is incomplete after 20 weeks of gestation.

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