Chapter 1 : Abortion Diagnosis Coding

When a claim for an abortion hits your desk, you should know that some abortion diagnoses require fifth digits and if
you dont submit the right one, your payer could deny your claim for lack of medical necessity.
Get to Know What 5th Digits Mean
Some abortion codes require a fifth digit of 1 (incomplete), 2 (complete) or 0 (unspecified in the documentation
whether it was incomplete or complete). But the application of these fifth digits will differ depending on the type of
abortion.
A fifth digit of 1 (incomplete) indicates that the uterus has not expelled all of the products of conception, according to
the current ICD-9-CM Official Guidelines for Coding and Reporting (Chapter 11, Section K.1.). A fifth digit of 2
(complete) indicates that all conception products are gone from the uterus prior to the episode of care.
Apply 5th Digits to Spontaneous Abortion Codes
When using the abortion codes for spontaneous abortion (634.xx), code based on these two rules: When the
spontaneous abortion is incomplete, the ob-gyn may intervene surgically to remove the remaining products (59812,
Treatment of incomplete abortion, any trimester, completed surgically) and will link this procedure to the reason for
doing it. This will be an incomplete spontaneous abortion, 634.11 (Spontaneous abortion incomplete complicated by
delayed or excessive hemorrhage) if she has bleeding. Youll apply the fifth digit of 1 because she expelled part of the
products prior to the current encounter.
In the case of a complete spontaneous abortion, you will report 634.92 (Spontaneous abortion complete without
complication) for the encounter if the physician notes no complications of the complete abortion and determines she
has expelled all the products of conception prior to the current encounter.
Review the Induced Abortion Codes
Now look at the codes for a legally induced (meaning either elective or therapeutic), self-induced or unspecified
abortion (635-637).
The fifth digits of incomplete or complete can easily apply to either a self-induced or unspecified abortion (in which
some of conception products could have been expelled prior to a current visit).
Advice: The more specific ICD-9 codes you have for this area the better.
Zero in on legally induced abortions: However, a legally induced abortion by definition implies that no products of
conception were passed prior to the visit at which, the physician handles the abortion surgically or medically
manages it for the first time. Therefore, your only choice for a fifth digit would be what is known at the end of the visit.
In other words, if the encounter is for a surgical abortion (for instance, 59840, Induced abortion, by dilation and
curettage), you cannot assign a fifth digit of 1 (incomplete). The reason is that prior to the visit, the patient had no
evidence of an incomplete abortion. At the end of the encounter, the physician will deem the abortion complete in
almost every case. You should assign 635.2x (Legally induced abortion) to the encounter.

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Rationale: This would fall under the additional rules in ICD-9 guidelines that you may code the reason for the visit or
what is known at the end of the visit if symptoms no longer apply.
But if the ob-gyn medically induces the patients abortion, the circumstance at the visits end is less clear.
Examine medically induced abortions: A medical abortion is one that is brought about by taking medications that
will end a pregnancy. The ob-gyn can use either of two medications, mifepristone or methotrexate, for medical
abortion. The patient takes each of these medications together with another medication, misoprostol, to induce an
abortion. This can take anywhere from about a day to three-four weeks from the time a woman takes the first
medication until the medical abortion is complete.
Therefore, at the end of the encounter, you should apply a fifth digit of 0 (unspecified in the documentation whether it
was incomplete or complete). Your ob-gyn cannot document a complete or incomplete abortion at this visit. For
instance, youll use 635.90 (Legally induced abortion unspecified without complication) if the patient has no
complications at the time of the encounter. You can code for follow-up to a medically induced abortion prior to
verification of a complete abortion using the incomplete fifth digit.
Throw the 5th Digit out the Window for These Abortion Codes
Thankfully, not all abortion diagnosis codes require the tricky fifth digit. Sort through these three- and four-digit ICD-9
codes before you tackle the fifth-digit possibilities you may save yourself time and headaches.
630 Hydatidiform mole
A hydatidiform mole results from overproduction of the tissue that is supposed to develop into the placenta. The
placenta normally feeds a fetus during pregnancy. In this condition, the tissues develop into an abnormal growth,
called a mass. Often, the patient has no fetus at all.
631 Other abnormal product of conception
A blighted ovum is a common cause of early pregnancy loss. It occurs when a fertilized egg develops a placenta and
membrane but no embryo. A blighted ovum usually occurs in the first few weeks of pregnancy, and an ultrasound will
show an empty gestational sac. Blighted ovum is often due to chromosomal abnormalities in the fertilized egg.
632 Missed abortion
A missed abortion is the in utero death of the embryo or fetus before the 22nd week of gestation with retained products
of conception.
Watch out: Your ob-gyn may refer to missed abortions as blighted ovum, anembryonic pregnancy, or fetal demise.
However, from an ICD-9 perspective, you would code the blighted ovum or anembryonic pregnancy with 631. Instead,
you should use 632 for a fetus death prior to 22 completed weeks, rather than 20 weeks.
638.x Failed attempted abortion
In a failed attempted abortion, the patient attempted at a previous encounter an elective abortion that failed to
remove the products of conception. As a result, complications may have ensured that the ob-gyn must treat at this
encounter.
639.x Complications following abortion and ectopic and molar pregnancies
Once your ob-gyn has treated or managed an abortion event and completed it at a previous encounter (reported with
630-633 or 634-638), you should report any complication of that abortion at a subsequent visit using 639.
Be sure you know the difference between 630-633 (Ectopic and Molar Pregnancy) and 634-639 (Other Pregnancy with

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Abortive Outcome). These differences matter to the selection of the appropriate ICD-9 code.
Highlight These 4 Stages of Spontaneous Abortion
A spontaneous abortion (miscarriage) is the end of a pregnancy at a stage where the embryo or the fetus is incapable
of surviving, generally defined at a gestation of prior to 20 weeks.
Unlike the threatened abortion codes, ICD-9 does not apply the 22-week criterion to a spontaneous abortion. This type
of abortion is a process that can be divided into four stages:

Threatened
Inevitable
Incomplete
Complete

Threatened: A threatened abortion consists of any vaginal bleeding before 22 completed weeks of gestation without
cervical dilatation or change in cervical consistency. Usually, no significant pain exists, although mild cramps may
occur, but the patient has not expelled any products of conception. You should not code this event as a spontaneous
abortion but rather report it as a threatened abortion (640.xx, Hemorrhage in early pregnancy) or 649.5x (Spotting
complicating pregnancy).
Inevitable: Similarly, the inevitable abortion is an early pregnancy event usually characterized by vaginal bleeding,
uterine cramping, dilatation of the cervix, and possibly rupture of the membranes, but no tissue has passed yet. You
should code this using category 640.xx.
Incomplete: An incomplete spontaneous abortion is a pregnancy associated with vaginal bleeding, dilatation of the
cervical canal, and passage of some conception products. Usually, the cramps are intense, and the vaginal bleeding is
heavy. Patients describe passage of tissue, or the physician observes evidence of tissue passage within the vagina. An
ultrasound, if performed, will confirm that some of the conception products are still present in the uterus.
Complete: A complete abortion is a completed miscarriage. Typically, a history of vaginal bleeding, abdominal pain
and tissue passage exists. After the tissue passes, the patient notes that the pain subsides and the vaginal bleeding
significantly diminishes. The examination reveals some blood in the vaginal vault, a closed cervical os, and no uterus
tenderness.

- Published on 2015-01-01

CPT 2014 American Medical Association. All rights reserved.