Abortion medicine and ICD-10 coding (2023)

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  • VonErica E. Remer, MD, CCDS
  • 23. mayo 2022

Abortion medicine and ICD-10 coding (1)

Medical terminology of a non-term fetus.

Today I'm going to talk about a topic that seems very politically charged right now, but I'm not really going to go there.There. I would like to reiterate the term "abortion" in medical terminology and discuss procedures related to an unborn fetus.

People generally don't read textbooks. Although ovulation is generally stated to occur approximately 14 days before the onset of menses, with a fertile window of approximately six days prior to and including the day of ovulation, the actual time during which a woman can become pregnant is quite variable. and often unpredictable. Teenage girls and those in perimenopause, as well as women with irregular periods, have even less reliable timing.

Fertilization of the egg by sperm occurs in the fallopian tube during this fertile period and under normal circumstances the fertilized egg travels downward until it reaches the uterus and the 70-100 cell blastocyst implants against the uterine wall. Opinions differ as to whether conception is considered the time of fertilization or implantation. However, unless implantation occurs (at a normal uterine site), there is no chance that a pregnancy will result in the birth of a baby. The fertilized but not implanted egg is expelled during menstruation.

The word "embryo" refers to the period from implantation to the end of the eighth week after conception. From the ninth week it is called a "fetus". At the time of birth, the term "newborn" is newborn or infant. Fetuses are not viable before 22 weeks of gestation, and the chance of survival increases to 60 to 70 percent after 24 weeks of gestation. About 40 percent of premature babies at this age experience long-term health complications.

An ectopic pregnancy occurs when a fertilized egg grows outside the main cavity of the uterus. More than 90 percent of these occur in a fallopian tube at high risk of rupture. Other locations are the ovaries, in an abnormal area of ​​the uterus (such as the cornual, cervix, or in a C-section scar), or the abdomen. Ectopic pregnancies can be further complicated when they occur along with an intrauterine pregnancy, often because they are more common with infertility treatments. “Uncomplicated” ectopic pregnancies ICD-10-CM codes are found in O00.- and codes for ectopic and molar pregnancies with complications are found in O08.-.

Fetal survival in an ectopic pregnancy is extremely rare and there is a serious threat to the life of the mother if it is not terminated in time. The only treatment for an ectopic pregnancy is termination of the pregnancy and often requires surgery that results in excision/resection of the affected body part.

The medical definition of abortion is "the termination of a pregnancy after the death of the embryo or fetus, accompanied by or immediately thereafter." Secondary definitions are "spontaneous expulsion of a human fetus during the first 12 weeks of gestation" and "induced expulsion of a human fetus".

In other words, a miscarriage is medically called a miscarriage. The most common causes of miscarriage are genetic or chromosomal abnormalities, placental problems, maternal medical or anatomical conditions, and infections. Miscarriages most often occur so early in the pregnancy (0-6 weeks) that the patient may not even know she is pregnant and may think it is just a late period. It is estimated that between 10 and 15 percent of known pregnancies end in miscarriage.

When the embryo or fetus dies and the body naturally expels all the products of conception, it is called a "complete abortion." If some of the products pass but some parts of the fetus, placenta, or membranes remain, it is called an "incomplete abortion." An "unavoidable miscarriage" is the scenario in which the cervix has dilated in preparation for labor, but has not yet done so. For some coding reason beyond my understanding as a physician, inevitable abortion points to O03.4, incomplete miscarriage without complications.

A 'miscarriage' (O02.1) is when a fetus has died (not nearby, usually days or weeks ago) but the body does not proceed to expel the non-viable intrauterine pregnancy. A “septic abortion” is a consequence of intrauterine infection after an abortion. Finally, an “imminent termination of pregnancy” (O20.0) is vaginal bleeding during pregnancy before the 20th week of gestation with the cervix closed (ie, not an unavoidable termination of pregnancy). A total of 25 percent of pregnancies result in bleeding early in the pregnancy, and about half of these result in the termination of the pregnancy.

There are other pregnancy complications that may result in the need to remove non-viable products of conception. These include an affected oocyte (O02.0) in which an early embryo never develops or stops, and a hydatoid mole (also known as a molar pregnancy, O01.-) when a benign tumor forms instead of a healthy placenta. . Complete and incomplete spontaneous abortions and their complications such as pelvic infection, hemorrhage, sepsis, and shock are coded under O03.-.

(Video) Missed Abortion CPT code - simplify medical coding

These spontaneous pregnancy losses differ from elective termination of pregnancy. The ICD-10-CM distinguishes between consultation for elective abortion without complications (Z33.2) and conditions/complications after induced (O04.-) or failed (O07.-) abortion.

Induction of an abortion can be accomplished by medical or procedural means. Current Procedural Terminology (CPT) codes are used for outpatient procedures. The American College of Obstetrics and Gynecology (ACOG) recommends reporting abortions after 20 weeks with a delivery code. However, they say that some state legislatures legislate the distinction between a miscarriage and a stillbirth by number of weeks or by weight, and this may guide the choice of the CPT code.

When a patient is hospitalized, ICD-10 PCS codes are used. The body part for the obstetrics section is always a version of the products of conception (POC, retained products, or fallopian tubes).

  • When delivery of delivery devices is manual without instrumentation, whether live birth, term fetus, or non-viable delivery devices such as stillbirth, the code is 10E0XZZ delivery of delivery devices, external access.
  • When assistance is needed, such as forceps or vacuum extraction, the root surgery is D-extraction.
  • Extraction is also the appropriate root surgery for retained or ectopic products of conception through natural/artificial opening, with or without endoscopic assistance.
  • However, I found it interesting that in an ectopic pregnancy that requires surgery, such as a salpingectomy, the PCS code can still be found in the Obstetrics section. Root surgery is resection, and the body part is the product of conception, ectopic. Treatment of an ectopic pregnancy is not considered and is not coded in the abortion section.
  • If the intention and result is elective abortion, that is, abortion, the root operation is A-abortion. I imagine that the most commonly used approach is through a natural or artificial opening (with or without an endoscope), and the last character indicates whether vacuum extraction, laminaria, abortion, or simple curettage (no qualifier) ​​was used.
  • D&C stands for dilation and curettage, in which the uterine lining is scraped away with a sharp instrument. This can be used after a miscarriage (root removal surgery) or for elective abortions (root removal surgery) to remove the lining of the uterus.
  • D&E stands for dilation and evacuation. It usually uses a combination of vacuum aspiration and the use of surgical tools. Which root operation this procedure falls under in ICD-10 PCS again depends on what the intent was (eg.

I hope this sheds light on the definitions, ICD-10-CM diagnoses, and procedure codes of miscarriage and abortion. That's the best I can do.


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Abortion medicine and ICD-10 coding (5)

Erica E. Remer, MD, CCDS

Erica Remer, MD, FACEP, CCDS, has a unique perspective as a practicing ER physician for 25 years with extensive experience in coding, CDI, and ICD-10. As a medical consultant for the University Hospitals Health Care System in Cleveland, Ohio, she spent four years training 2,700 providers on ICD-10, completing hundreds of consultations, fighting numerous DRG clinical decisions and medical necessity denials, and training CDI specialists and healthcare providers with dedicated case-related presentations. In July 2016 she moved into independent consulting. dr. Remer is a member of the editorial board of ICD10monitor and co-host of the popular weekly live Internet radio shows Talk Ten Tuesdays.

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(Video) Incomplete Abortion CPT codes - simplify medical coding

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What is the ICD-10 code for medication abortion? ›

ICD-10 code Z33. 2 for Encounter for elective termination of pregnancy is a medical classification as listed by WHO under the range - Factors influencing health status and contact with health services .

What is the diagnosis code for misoprostol? ›

HCPCS Code for Misoprostol, oral, 200 mcg S0191.

What is the procedure code for medical abortion? ›

Methods for Medically Inducing the Termination of Pregnancy Early medical Early medical terminations are typically J3490, S0190, performed on an outpatient basis.

What is the ICD-10 code for complete or unspecified spontaneous abortion without complication? ›

9: Spontaneous abortion Complete or unspecified, without complication.

What is ICD-10 code 10E0XZZ? ›

A spontaneous delivery is a vaginal delivery that is manually assisted with no use of instrumentation such as forceps or vacuum extraction. In ICD-10-PCS, the code for this procedure will be the same every time, 10E0XZZ.

What is ICD-10-PCS 10E0XZZ? ›

Delivery of Products of Conception, External Approach

What is the ICD-10 code for follow up after termination of pregnancy? ›

ICD-10 code O03. 6 for Delayed or excessive hemorrhage following complete or unspecified spontaneous abortion is a medical classification as listed by WHO under the range - Pregnancy, childbirth and the puerperium .

What is the diagnosis code for medication management? ›

2023 ICD-10-PCS Codes HZ8*: Medication Management.

What is the classification of misoprostol? ›

Cytotec belongs to a class of drugs called Gastrointestinal Agents, Other; Prostaglandins, Endocrine.

Is abortion a qualified medical expense? ›

According to the IRS, legal abortions qualify as eligible medical expenses. It's important to know that before HSA funds may be used, the plan deductible must be met.

Is an abortion considered a medical expense? ›

Definition of medical care includes legal abortion

213(d) (and so also Code Sec. 105) because it is for the purpose of affecting a structure or function of the body. Thus, abortion expenses are medical expenses (and so are deductible by an employer but excluded from income by the employee).

Is abortion included in medical insurance? ›

No. Most health insurance plans in India does not cover the cost of an abortion. However, most maternity health insurance plans cover the cost of abortion in India.

What is the ICD-10 code for personal history of abortion? ›

Encounter for elective termination of pregnancy

Z33. 2 is a billable/specific ICD-10-CM code that can be used to indicate a diagnosis for reimbursement purposes. The 2023 edition of ICD-10-CM Z33. 2 became effective on October 1, 2022.

What is the diagnosis of incomplete abortion? ›

Incomplete abortion is defined by clinical presence of an open cervical os and bleeding, whereby all products of conception have not been expelled from the uterus, or the expelled products are not consistent with the estimated duration of pregnancy. Common symptoms include vaginal bleeding and abdominal pain.

What are the differential diagnosis of incomplete abortion? ›

2 Differential diagnosis. The main differential diagnoses are: ectopic pregnancy, cervicitis, ectropion (eversion of the cervical mucosa, which is more fragile and may bleed easily on contact, especially after a vaginal examination or sexual intercourse), cervical polyp, and functional uterine bleeding.

What is ICD-10 code 10D00Z1? ›

ICD-10-PCS code 10D00Z1 for Extraction of Products of Conception, Low, Open Approach is a medical classification as listed by CMS under Pregnancy range.

What is ICD-10-PCS code 10A00ZZ? ›

ICD-10-PCS Code 10A00ZZ - Abortion of Products of Conception, Open Approach - Codify by AAPC.

What is ICD-10 code O99? ›

O99 Other maternal diseases classifiable elsewhere but complicating pregnancy, childbirth and the puerperium.

What is the coding guidelines for missed abortion? ›

ICD-10 code O02. 1 for Missed abortion is a medical classification as listed by WHO under the range - Pregnancy, childbirth and the puerperium .

Is there an ICD-10 code for pregnancy? ›

ICD-10 Code for Encounter for supervision of normal pregnancy, unspecified- Z34. 9- Codify by AAPC.

Which chapter of the ICD-10 is used to code for pregnancy? ›

Obstetric cases require diagnosis codes from chapter 15 of ICD-10-CM, “Pregnancy, Childbirth, and the Puerperium.” It includes categories O00–O9A arranged in the following blocks: O00–O08, Pregnancy with abortive outcome.

Can we CODE weeks of gestation with missed abortion? ›

Coding rules indicate that an abortion after 20 weeks 0 days is reported using a delivery code.
MISSED Abortion.
Possible CodeDescription
59820Before 14 weeks
5982114 weeks to 20 weeks

What is the CPT code for surgical treatment of missed abortion first trimester? ›

But in the case of missed abortions, you would report 59820 (Treatment of missed abortion, completed surgically; first trimester) or 59821 (... second trimester) instead of 59812 because 59820-59821 more specifically describe the service performed.

When should ICD-10 code Z09 be used? ›

Z09 ICD 10 codes should be used for diseases or disroder other than malignant neoplasm which has been completed treatment. For example, any history of disease should be coded with Z08 ICD 10 code as primary followed by the history of disease code.

Are ICD-10 codes required on prescriptions? ›

Diagnosis codes are always required on prescriptions for Medicare Part B claims. In addition some Prior Authorizations will require the submission of a diagnosis code. Even though it is not a covered HIPAA transaction, a Workers Compensation claim might also require a diagnosis code based on the injury of the patient.

What is the ICD-10 code for medication reconciliation? ›

The 2023 edition of ICD-10-CM Z51. 81 became effective on October 1, 2022. This is the American ICD-10-CM version of Z51.

Are diagnosis codes required on prescriptions? ›

Can I dispense a prescription if it does not contain a diagnosis or procedure code? Yes. While a pharmacist has the option to call a prescriber to obtain the code, paragraph (K) of rule 4729-5-30 does permit the processing of a prescription without the diagnosis code.

What is misoprostol FDA approved for? ›

Currently, misoprostol is FDA approved only for the prevention and treatment of NSAID-induced gastric ulcers in patients taking NSAIDs and at high risk for ulceration. It has an indication (but not FDA approved) in the short-term treatment of active duodenal or gastric ulcers with other etiologies.

What is the trade name for misoprostol? ›

Misoprostol is a medication that can prevent stomach ulcers if you also take NSAID medications. It reduces the amount of acid in your stomach, which protects your stomach lining. The brand name of this medication is Cytotec®.

Is misoprostol the same as oxytocin? ›

Misoprostol is a synthetic prostaglandin analogue commonly used for labor induction. It causes uterine contractions and ripening of the cervix. Oxytocin sold under the brand name Pitocin among others, is a medication made from the peptide oxytocin and is used to cause contraction of the uterus to start labor.

Does abortion have deductible? ›

SB 245 prohibits health plans and insurers from imposing a co-pay, deductible, or other cost-sharing requirement for abortion and abortion-related services.

Are abortion costs tax deductible? ›

In the United States, you can get a tax deduction for your abortion if your overall health care expenses are high enough. That didn't change with the Supreme Court's ruling last week. If you work for a nongovernmental employer that provides health insurance that covers abortion, the federal government helps there, too.

Are abortion pills FSA eligible? ›

Healthcare Flexible Spending Account (FSA)

With an FSA, legal abortions and travel are still considered an eligible and reimbursable expense and are tax-free. However, some FSAs are designed to be more limited when it comes to eligible expenses.

What is not considered a qualified medical expense? ›

Medical care expenses must be primarily to alleviate or prevent a physical or mental disability or illness. They don't include expenses that are merely beneficial to general health, such as vitamins or a vacation.

What are qualifying medical expenses? ›

Qualified Medical Expenses are generally the same types of services and products that otherwise could be deducted as medical expenses on your yearly income tax return. Some Qualified Medical Expenses, like doctors' visits, lab tests, and hospital stays, are also Medicare-covered services.

Is abortion medical malpractice? ›

Complications of abortion can be serious, resulting in permanent injury or wrongful death. If these complications were caused by negligence on the part of the abortion provider, you may be eligible to file a malpractice claim.

What is not covered in medical insurance? ›

Also, dental surgery/ treatment ( unless requiring hospitalization), congenital external defects, convalescence, venereal disease, general debility, use of intoxicating drugs/alcohol, Self-inflicted injuries, AIDS, diagnosis expenses, infertility treatment, and Naturopathy treatment make a list of exclusions under ...

What medical procedures are not covered by insurance? ›

What Healthcare Services Often Aren't Covered?
  • Adult Dental Services. ...
  • Vision Services. ...
  • Hearing Aids. ...
  • Uncovered Prescription Drugs. ...
  • Acupuncture and Other Alternative Therapies. ...
  • Weight Loss Programs and Weight Loss Surgery. ...
  • Cosmetic Surgery. ...
  • Infertility Treatment.

Are medicines covered under health insurance? ›

Health insurance is a type of insurance that covers medical expenses that arise due to an illness. These expenses could be related to hospitalisation costs, cost of medicines or doctor consultation fees.

When do you use code Z33 1? ›

If the pregnancy is incidental to an encounter for a different reason, code Z33. 1 (pregnant state, incidental) is assigned in place of any Chapter 15 codes. When treating the pregnant member, the codes in Chapter 15 of the ICD-10 codes set are applied before codes from other chapters.

What does ICD-10 code Z33 1 mean? ›

Z33. 1 (Pregnant state, incidental) O09. 90 (supervision of high risk pregnancy, unspecified, unspecified trimester)

What is the common name for Misoprostol? ›

Misoprostol (Cytotec) is also commonly used off-label for medical abortion (using prescribed medications to end a pregnancy) and inducing (starting) labor in people who are pregnant.

How to code missed abortion in ICD-10? ›

ICD-10 code O02. 1 for Missed abortion is a medical classification as listed by WHO under the range - Pregnancy, childbirth and the puerperium .

When should Z codes be used? ›

Z codes are for use in any healthcare setting. Z codes may be used as either a first-listed (principal diagnosis code in the inpatient setting) or secondary code, depending on the circumstances of the encounter. Certain Z codes may only be used as first-listed or principal diagnosis.

When do you use the diagnosis code Z09? ›

Follow codes (Z08-Z09) These codes indicated for continued surveillance (treatment has been completed and disease, condition, or injury no longer exists.

What does Z32 01 mean? ›

ICD-10 code Z32. 01 for Encounter for pregnancy test, result positive is a medical classification as listed by WHO under the range - Factors influencing health status and contact with health services .

What is the ICD-10 code for pregnancy prevention? ›

Under ICD-10 there is a family of diagnosis codes that are used to describe contraceptives. This family is the Z30—codes. Z30 is used to describe counseling or management of current contraceptive practices.

What is unacceptable principal diagnosis codes? ›

Unacceptable principal diagnosis is a coding convention in ICD-1O. Those identified codes do not describe a current illness or injury, but a circumstance which influences a patient's health status. These codes are considered to be unacceptable principal diagnosis codes.

Is misoprostol the same as Pitocin? ›

Misoprostol is a synthetic prostaglandin analogue commonly used for labor induction. It causes uterine contractions and ripening of the cervix. Oxytocin sold under the brand name Pitocin among others, is a medication made from the peptide oxytocin and is used to cause contraction of the uterus to start labor.

Why is misoprostol not used in pregnancy? ›


What is ICD-10 code for recurrent pregnancy loss? ›

ICD-10 code N96 for Recurrent pregnancy loss is a medical classification as listed by WHO under the range - Diseases of the genitourinary system .


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3. 2019 ICD-10-CM Coding Guidelines: Impending or Threatened Conditions
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4. How to Locate the Main Term in ICD-10-CM Code Lookup - Medical Coding Demonstration
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