CPT Code 59820 Treatment of Missed Abortion, Completed Surgically (Abortion Procedures)

Understanding CPT 59820

CPT 59820 is defined by the American Medical Association (AMA) as “Treatment of missed abortion, completed surgically; first trimester.”

This code describes the surgical management of a missed abortion (a miscarriage in which the embryo or fetus has died in utero but has not yet been expelled) during the first trimester — typically before 14 weeks of gestation.

The provider removes the pregnancy tissue surgically to prevent infection, hemorrhage, or other complications. The procedure is typically performed through dilation and curettage (D&C) or vacuum aspiration, using a vaginal approach.

Description of the Procedure

When a missed abortion occurs, the fetal tissue remains inside the uterus even though the fetus is no longer viable. The provider performs surgical evacuation to clear the uterine cavity.

The procedure involves:

• Cervical dilation to allow access to the uterus.
• Suction aspiration or curettage to remove fetal and placental tissue.
• Inspection of the uterus to ensure complete evacuation.
• Hemostasis and uterine tone assessment to prevent bleeding.

This is often performed in an operating room or surgical suite under general or regional anesthesia.

When to Use CPT 59820

Use CPT 59820 when:

• The provider surgically treats a missed abortion during the first trimester.
• The procedure is performed to remove retained products of conception following fetal demise.
• The patient presents with no fetal cardiac activity confirmed via ultrasound.
• Medical management (e.g., misoprostol) was attempted but failed to complete the miscarriage.

Do not report CPT 59820 when:

• The gestational age is beyond 14 weeks — use CPT 59821 instead.
• The abortion is induced or elective — use CPT 59840 or related codes.
• The procedure is performed for retained tissue after delivery — use CPT 59160.

Coding and Billing Guidelines

• Global Period: 90 days.
• Anesthesia: Local, regional, or general may be used.
• Site of Service: Commonly hospital, ASC, or outpatient surgical center.
• Payer Documentation: Must specify missed abortion and first trimester.
• Preauthorization: Recommended for certain payers, especially nonemergent cases.

Applicable Modifiers

• Modifier 52: For reduced services if the procedure was partially completed.
• Modifier 59: If performed with another unrelated service during the same session.
• Modifier 78: For unplanned return to the OR for completion or repeat evacuation.
• Modifier 22: For increased procedural complexity, such as extensive adhesions or scarring.

Documentation Requirements

Accurate documentation supports both clinical justification and proper coding. Include:

• Confirmation of missed abortion and absence of fetal cardiac activity.
• Gestational age at time of procedure (under 14 weeks).
• Surgical technique used (suction, curettage, or combined).
• Anesthesia type and intraoperative findings.
• Completion of evacuation and absence of complications.

Example Clinical Scenarios

Scenario 1 – Surgical Evacuation After Failed Medical Management

A 32-year-old patient diagnosed with a missed abortion at 10 weeks is treated with misoprostol, but follow-up ultrasound shows retained tissue. The provider performs suction curettage to complete the miscarriage.

✅ Code: CPT 59820 – Surgical treatment of missed abortion, first trimester.

🩺 Rationale: Procedure completed via vaginal approach using suction evacuation for a first-trimester missed abortion.

Scenario 2 – Early Fetal Demise with No Symptoms

A 27-year-old patient at 9 weeks gestation presents for routine ultrasound showing no fetal heartbeat. The provider performs a D&C to remove fetal and placental tissue.

✅ Code: CPT 59820 – D&C for missed abortion, first trimester.

🩺 Rationale: Fetal demise in utero confirmed, surgical evacuation completed vaginally.

Scenario 3 – Uterine Retention with Complications

A 35-year-old with a history of cesarean section presents with a missed abortion at 11 weeks. Ultrasound shows retained tissue despite cramping. The provider performs curettage under ultrasound guidance due to uterine adhesions.

✅ Code: CPT 59820 with Modifier 22 – Increased complexity due to scarring.

🩺 Rationale: Complex surgical evacuation required due to prior uterine surgery.

Common Coding Challenges

1. Confusing “Missed Abortion” with “Incomplete Abortion”

Coders often mistake these terms. Missed abortion means fetal demise with no expulsion of tissue; incomplete abortion means partial passage of products. Ensure the documentation specifies the diagnosis.

2. Incorrect Gestational Age Documentation

CPT 59820 applies only to first-trimester cases. If the pregnancy extends beyond 14 weeks, CPT 59821 must be reported instead. Always verify gestational age in the operative note.

3. Omission of Surgical Approach

This code assumes a vaginal approach. If the provider used another route (e.g., abdominal), documentation must clarify it — or the code may be disputed.

4. Failure to Note Fetal Demise Confirmation

Payers may deny claims if there is no diagnostic confirmation of fetal death. Include ultrasound findings or physician statement verifying absence of cardiac activity.

5. Reporting 59820 for Induced Procedures

CPT 59820 is only for missed abortions — not elective or induced terminations. Use CPT 59840 for induced abortion procedures to avoid audit risk.

6. Global Period Overlap

If the patient returns for follow-up within 90 days, postoperative care is included and should not be billed separately.

BillingFreedom Insight:

The keys to clean claims for missed abortion procedures are accurate diagnosis linkage, confirmed fetal demise, and clear surgical documentation. Even minor omissions can result in payer rejections or audits.

Reimbursement Information

• Average Medicare Reimbursement: Approximately $350–$500, depending on geographic location and site of service.
• Global Period: 90 days.
• Multiple Surgery Reduction: Applies when billed with additional major procedures.
• Preauthorization: Often required for elective or outpatient surgical management.

Partner with BillingFreedom for Expert OB-GYN Revenue Solutions

Procedures like CPT 59820 require more than accurate coding, they demand empathy, precision, and full compliance with payer and CMS standards. At BillingFreedom, our certified team specializes in OBGYN medical billing services, ensuring every claim reflects the correct diagnosis, trimester, and surgical detail.

We help OBGYN practices:

• Minimize denials with proactive documentation audits
• Apply correct CPT and ICD-10 pairings for pregnancy complications
• Stay compliant with AAPC and CMS updates
• Optimize reimbursement through clean, first-pass claims

With BillingFreedom, you focus on patient care while we handle every billing detail with accuracy and compassion.

For more details about our exceptional medical billing services, please don't hesitate to contact us via email at info@billingfreedom.com or call us at +1 (855) 415-3472. 

Your financial tranquility is our priority!