Accurate billing and medical coding for abortion services are essential for proper reimbursement and compliance with healthcare regulations. The process involves selecting appropriate ICD-10 diagnosis codes and CPT procedure codes, which can vary based on the type of abortion and the specific services provided.
Pregnancy complications, including placental abruption, bleeding from placenta previa, preeclampsia or eclampsia, and cardiac or renal conditions, may be so severe that abortion is the only measure to preserve a woman’s health or save her life
ICD-10 Diagnosis Codes
The ICD-10 coding system classifies abortions into several categories:
Spontaneous Abortion (Miscarriage): Codes 634.x to 636.x are used, with the fourth digit indicating the contributing complication.
Elective Abortion: Codes 635.x are designated for legally induced abortions performed without medical justification.
Therapeutic Abortion: Codes 636.x apply to medically necessary abortions performed to preserve the health or life of the mother.
It’s crucial to accurately identify the type of abortion to assign the correct diagnosis code.
CPT Procedure Codes
CPT codes for abortion procedures include:
Surgical Procedures:
- Dilation and Curettage (D&C): 58120
- Dilation and Evacuation (D&E): 59160
Medical Procedures:
- Medication abortion using mifepristone and misoprostol: HCPCS code S0199
The choice of procedure code depends on the method used and the gestational age of the pregnancy.
Modifiers:
When billing for abortion services, especially under Medicare, it’s important to use the appropriate modifiers:
- Modifier G7: Indicates that the pregnancy resulted from rape or incest, or that the pregnancy is life-threatening to the mother.
This modifier ensures compliance with Medicare’s coverage criteria for abortion services.
CPT Modifiers
https://codingclarified.com/cpt-medical-modifiers/
Billing Considerations:
Documentation: Ensure that all services related to the abortion, including counseling, office visits, and follow-up care, are thoroughly documented.
Payer Policies: Billing practices can vary among payers. It’s essential to verify specific coding and billing requirements with each payer to ensure accurate reimbursement.
Global Billing: Some payers may require a global billing approach for abortion services, encompassing all related procedures and visits under a single code.
For comprehensive guidance, refer to resources such as the AAPC’s article on coding abortions
Obstetrics:
Here’s the Secret to Coding Abortions: Determining the Type from AAPC
Reproductive Health Access Project’s coding guide for medication abortion
Staying informed about the latest coding updates and payer-specific requirements is crucial for accurate billing and reimbursement in abortion services.