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Date Printed: October 20, 2017: 02:03 PM

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This medical policy (medical coverage guideline) is Copyright 2017, Blue Cross and Blue Shield of Florida (BCBSF). All Rights Reserved. You may not copy or use this document or disclose its contents without the express written permission of BCBSF. The medical codes referenced in this document may be proprietary and owned by others. BCBSF makes no claim of ownership of such codes. Our use of such codes in this document is for explanation and guidance and should not be construed as a license for their use by you. Before utilizing the codes, please be sure that to the extent required, you have secured any appropriate licenses for such use. Current Procedural Terminology (CPT) is copyright 2017 American Medical Association. All Rights Reserved. No fee schedules, basic units, relative values, or related listings are included in CPT. The AMA assumes no liability for the data contained herein. Applicable FARS/DFARS restrictions apply to government use. CPT® is a trademark of the American Medical Association. The use of specific product names is illustrative only. It is not intended to be a recommendation of one product over another, and is not intended to represent a complete listing of all products available.

03-59800-01

Original Effective Date: 11/15/01

Reviewed: 08/27/09

Revised: 09/22/17

Subject: Abortion

THIS MEDICAL COVERAGE GUIDELINE IS NOT AN AUTHORIZATION, CERTIFICATION, EXPLANATION OF BENEFITS, OR A GUARANTEE OF PAYMENT, NOR DOES IT SUBSTITUTE FOR OR CONSTITUTE MEDICAL ADVICE. ALL MEDICAL DECISIONS ARE SOLELY THE RESPONSIBILITY OF THE PATIENT AND PHYSICIAN. BENEFITS ARE DETERMINED BY THE GROUP CONTRACT, MEMBER BENEFIT BOOKLET, AND/OR INDIVIDUAL SUBSCRIBER CERTIFICATE IN EFFECT AT THE TIME SERVICES WERE RENDERED. THIS MEDICAL COVERAGE GUIDELINE APPLIES TO ALL LINES OF BUSINESS UNLESS OTHERWISE NOTED IN THE PROGRAM EXCEPTIONS SECTION.

           
Position Statement Billing/Coding Reimbursement Program Exceptions Definitions Related Guidelines
           
Other References Updates    
           

DESCRIPTION:

Abortion is the premature expulsion of the products of conception from the uterus.

POSITION STATEMENT:

NOTE: Refer to member’s/subscriber’s contract benefits.

Abortion may be eligible for coverage for any of the following:

BILLING/CODING INFORMATION:

CPT Coding:

59812

Treatment of incomplete abortion, any trimester, completed surgically

59820

Treatment of missed abortion, completed surgically; first trimester

59821

Treatment of missed abortion, completed surgically; second trimester

59830

Treatment of septic abortion, completed surgically

59840

Induced abortion, by dilation and curettage

59841

Induced abortion, by dilation and evacuation

59850

Induced abortion, by one or more intra-amniotic injections (amniocentesis-injections), including hospital admission and visits, delivery of fetus and secundines;

59851

Induced abortion, by one or more intra-amniotic injections (amniocentesis-injections), including hospital admission and visits, delivery of fetus and secundines; with dilation and curettage and/or evacuation

59852

Induced abortion, by one or more intra-amniotic injections (amniocentesis-injections), including hospital admission and visits, delivery of fetus and secundines; with hysterotomy (failed intra-amniotic injection)

59855

Induced abortion, by one or more vaginal suppositories (e.g., prostaglandin) with or without cervical dilation (e.g., laminaria), including hospital admission and visits, delivery of fetus and secundines;

59856

Induced abortion, by one or more vaginal suppositories (e.g., prostaglandin) with or without cervical dilation (e.g., laminaria), including hospital admission and visits, delivery of fetus and secundines; dilation and curettage and/or evacuation

59857

Induced abortion, by one or more vaginal suppositories (e.g., prostaglandin) with or without cervical dilation (e.g., laminaria), including hospital admission and visits, delivery of fetus and secundines; with hysterotomy (failed medical evacuation)

59866

Multi-fetal pregnancy reductions(s) (MPR)

HCPCS Coding:

S0190

Mifepristone, oral 200 mg

S0191

Misoprostol, oral 200 mcg

S0199

Medically induced abortion by oral ingestion of medication including all associated services and supplies (e.g., patient counseling, office visits, confirmation of pregnancy by HCG, ultrasound to confirm duration of pregnancy, ultrasound to confirm completion of abortion) except drugs (non-covered)

S2260

Induced abortion, 17 – 24 weeks

S2265

Induced abortion, 25 – 28 weeks

S2266

Induced abortion, 29 – 31 weeks

S2267

Induced abortion, 32 weeks or greater

S8055

Ultrasound guidance for multi-fetal pregnancy reduction(s), technical component (only to be used when the physician doing the reduction procedure does not perform the ultrasound, guidance is included in the CPT code for multi-fetal pregnancy reduction-59866)

ICD-10 Diagnoses Codes That Support Medical Necessity for 59812 and 59830:

O03.0 – O03.2

Spontaneous abortion

O03.30 – O03.39

Other and unspecified complications following incomplete spontaneous abortion

O03.4

Incomplete spontaneous abortion without complication

ICD-10 Diagnoses Codes That Support Medical Necessity for 59820:

O02.1

Missed abortion

ICD-10 Diagnoses Codes That Support Medical Necessity for 59821:

O02.1

Missed abortion

O36.4XX0 – O36.4XX9

Maternal care for intrauterine death

O03.4

Spontaneous abortion without mention of complication

REIMBURSEMENT INFORMATION:

None applicable.

PROGRAM EXCEPTIONS:

Federal Employee Program (FEP): Follow FEP guidelines.

State Account Organization (SAO): Follow SAO guidelines.

Medicare Advantage products:No Local Coverage Determination (LCD) was found at the time of the last guideline reviewed date.

The following National Coverage Determinations (NCDs) was reviewed on the last guideline reviewed date: Abortion, (140.1) located at cms.gov.

DEFINITIONS:

Incomplete abortion: the expulsion of some products of conception with the remainder evacuated surgically.

Missed abortion: an empty gestational sac, blighted ovum, or a fetus or fetal pole without a heartbeat prior to completion of 20 weeks 0 days gestation. NOTE: that ICD-9 –CM defines missed abortion as any fetal death prior to completion of 22 weeks gestation.

Secundines: the placenta and membranes expelled after childbirth; the afterbirth.

Spontaneous abortion: naturally occurring expulsion of a nonviable fetus.

RELATED GUIDELINES:

None applicable.

OTHER:

None applicable.

REFERENCES:

  1. American College of Obstetricians and Gynecologists (ACOG)-Coding for Medical and Surgical Termination of Pregnancy/Stillbirths, 2006.
  2. Centers for Medicare & Medicaid Services (CMS) NCD for Abortion (140.1), 06/19/06.
  3. U.S. Food and Drug Administration (FDA)-Mifeprex (mifepristone) Information 03/17/06.

COMMITTEE APPROVAL:

This Medical Coverage Guideline (MCG) was approved by the BCBSF Medical Policy & Coverage Committee on 08/27/09.

GUIDELINE UPDATE INFORMATION:

03/15/01

Medical Coverage Guideline Reformatted.

11/15/01

Medical Coverage Guideline Revised.

01/01/02

HCPCS coding changes.

10/01/02

HCPCS Update, added code S2262, S2265, S2266, S2267.

11/15/03

Routine review; no change MCG changed to Active but no longer scheduled for routine review.

10/15/04

Medical Coverage Guideline format changes.

05/15/06

Added spontaneous abortion and missed abortion to when services are covered. Added covered ICD-9 diagnosis for 59812, 59820, 59821 and 59830. Defined “incomplete abortion”, “missed abortion” and “spontaneous abortion”, add to definitions section. Added program exception for Medicare Advantage products. Updated references.

01/01/07

HCPCS update. Revised S2260, S2265, S2266, S2267 descriptor. Deleted S2262.

08/15/07

Reformatted guideline. Deleted Medicare Advantage products program exception. Updated references.

09/15/09

Annual review. No change in position statement. Updated coding and references.

02/15/11

Revision; related ICD-10 codes added.

05/11/14

Revision: Program Exceptions section updated.

10/01/15

Revision; updated ICD9 and ICD10 coding section. Updated references.

09/22/17

Revision, updated ICD10 coding section.

Date Printed: October 20, 2017: 02:03 PM