Error-free coding and billing for the surgical treatment of incomplete abortions are essential for OBGYN practices. It ensures financial stability and compliance within the local healthcare system.
This guide offers a comprehensive overview of the CPT code 59812. It will help your practice navigate the complexities of billing for the removal of retained products of conception via the vagina.
We will share valuable insights into various clinical situations where this surgical intervention is necessary, along with its applicable modifiers.
What’s more? We will outline the key billing and reimbursement considerations relevant to this procedure.
CPT Code 59812 – Description
CPT code 59812 is from the ‘Abortion Procedures’ code range and is maintained by the American Medical Association (AMA). It covers surgical removal of products of conception via a vaginal approach that were not naturally expelled during a miscarriage.
Scenarios Where CPT Code 59812 is Applicable
Let’s take a look at a few real-world clinical scenarios where this CPT code applies:
Retained Tissue After Spontaneous Abortion
Picture a 31-year-old female who is 9 weeks pregnant. She visited the emergency room with heavy bleeding and cramping. Ultrasound confirms a spontaneous abortion (miscarriage). However, a significant gestational sac tissue remains within the uterus.
Therefore, the gynecologist performs a surgical evacuation via a vaginal approach to remove the unexpelled products of conception. Here, CPT code 59812 applies.
Incomplete Miscarriage with Hemodynamic Instability
Imagine a 28-year-old female 12 weeks into pregnancy. She comes to the OBGYN clinic after a spontaneous abortion at home and passes some tissue. She complains about persistent heavy bleeding, dizziness, and signs of hemodynamic instability.
The gynecologist orders an ultrasound. It reveals a significant amount of retained placental tissue in the uterus. Therefore, the provider performs a surgical completion of the abortion via a vaginal approach due to her ongoing bleeding and instability. The gynecologist reports CPT code 59812 to bill for the procedure.
Incomplete Abortion with Infection Concerns
Consider a 36-year-old female who is 10 weeks pregnant and experienced a spontaneous abortion 1 week ago. She visits the clinic and complains of persistent pelvic pain, high fever, and foul-smelling vaginal discharge.
The gynecologist orders an ultrasound. The images reveal retained products of conception within the uterus. The physician suspects a developing uterine infection and performs a surgical evacuation via a vaginal approach (CPT code 59812).
Applicable Modifiers for CPT Code 59812
Discussed below are a few applicable modifiers related to this surgical procedure:
Modifier 22
Append modifier 22 to CPT code 59812 when the surgical removal of products of conception requires extra time, effort, or resources beyond what is typically needed.
For instance, a female patient was 18 weeks into pregnancy when she spontaneously miscarried. Thus, the placenta was more developed and required extra effort (teasing it out) with the usual scraping (curettage) to remove everything.
Modifier 57
Modifier 57 indicates the physician made the decision to perform the surgery during the same evaluation and management (E/M) visit or shortly after.
For instance, a patient visits an OBGYN for the very first time and has a serious issue, such as heavy bleeding with cramps after a spontaneous abortion. Thus, the physician decides to perform the surgical removal of the remaining product of conception (CPT code 59812) during the initial E/M visit.
CPT Code 59812 – Billing & Reimbursement Guidelines
The following are the reimbursement and billing requirements related to the CPT 59812:
Ensure Adequate Documentation
Complete and accurate documentation is essential for supporting medical necessity and ensuring timely claim processing. Thus, your documentation when billing CPT code 59812 should include the following:
- Date of service.
- The reason for the incomplete abortion.
- Ultrasound images and findings that hint at the remaining products of conception.
- Details of how the physician performed the procedure and what was removed.
- List complications during the procedure (if any).
- Mention details about the post-operative care instructions.
Beware of the 90-day Global Period and Bundling Rules
The CPT code 59812 has a global period of 90 days. For the unversed, it is the post-operative time frame during which all the related services are bundled into the surgical procedure fee.
Thus, you should avoid separate billing of post-operative care. Also, you can append the relevant modifier, such as 57, to bypass the bundling rules and ensure rightful reimbursements.
Understanding Specific Payer Policies
Bundling rules, reimbursement rates, and documentation requirements significantly vary across payers. Therefore, you should always strive to stay informed about the relevant payer guidelines and ensure adherence to all rules before submitting a claim with CPT code 59812.
Summary
Now that we have covered all aspects of CPT code 59812, it is time to wrap up this guide. However, before bidding adieu, let’s recap everything we discussed.
We explained that CPT 59812 covers the surgical removal of the products of conception via a vaginal approach that were left unexpelled during an abortion.
Next, we discussed some clinical scenarios where the CPT 59812 applies. These include incomplete abortion with infection concerns, incomplete miscarriage with hemodynamic instability, and retained tissue after spontaneous abortion.
Besides, we shared that modifier 57 applies to this procedural code when the physician decides to perform this surgery during an initial E/M visit. Contrarily, modifier 22 applies when the procedure takes significantly more time, effort, and resources than typically required.
Finally, we looked into billing and reimbursement guidelines related to this surgical procedure.
We shared a comprehensive guide that will help you streamline billing for CPT 59812. However, if you have trouble handling it in-house, you can acquire professional OBGYN billing services from MediBillMD.
