How To Use CPT Code 59855

CPT 59855 describes the procedure for induced abortion using vaginal suppositories, with or without cervical dilation. This article will cover the description, official details, procedure, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information and billing examples.

1. What is CPT Code 59855?

CPT 59855 can be used to describe the procedure of induced abortion using vaginal suppositories. This code includes the insertion of suppositories to induce labor contractions and may also involve the use of a cervical dilator. The provider admits the patient to the hospital, manages the labor process, and delivers the fetus and placenta. This procedure is typically performed after the first trimester of pregnancy.

2. Official Description

The official description of CPT code 59855 is: ‘Induced abortion, by 1 or more vaginal suppositories (eg, prostaglandin) with or without cervical dilation (eg, laminaria), including hospital admission and visits, delivery of fetus and secundines.’

3. Procedure

1. The provider admits the patient to the hospital and performs an admission history and physical examination.
2. The patient is positioned in a dorsal lithotomy position in the procedure room.
3. The provider inserts a laminaria into the cervix to dilate it, if necessary.
4. Vaginal suppositories, such as prostaglandin, are inserted every three to four hours until labor begins.
5. Once labor begins, the provider monitors the patient as they would for a vaginal delivery.
6. The provider delivers the fetus and placenta vaginally.
7. The provider inspects the perineum and vagina for lacerations and performs repairs if necessary.
8. The provider provides post-procedure care to the patient until discharge.

4. Qualifying circumstances

CPT 59855 is performed for the termination of a pregnancy intentionally using vaginal suppositories. The procedure may involve cervical dilation with laminaria. It is typically performed after the first trimester of pregnancy, or after fourteen weeks of gestation. The provider manages the entire process, including hospital admission, visits, delivery of the fetus and placenta, and post-procedure care.

5. When to use CPT code 59855

CPT code 59855 should be used when a provider performs an induced abortion using vaginal suppositories, with or without cervical dilation. It is important to note that this code is specific to the procedure described and should not be used for other abortion methods or circumstances.

6. Documentation requirements

To support a claim for CPT 59855, the provider must document the following information:

• Reason for the induced abortion
• Details of the procedure, including the use of vaginal suppositories and cervical dilation (if applicable)
• Date of the procedure
• Start and end time of the procedure
• Any complications or additional procedures performed
• Delivery of the fetus and placenta
• Post-procedure care provided
• Signature of the provider

7. Billing guidelines

When billing for CPT 59855, ensure that the procedure meets the criteria described in the official description. It is important to accurately report the details of the procedure and provide appropriate documentation. CPT 59855 should not be reported with other abortion procedure codes. Review the specific billing guidelines provided by the payer to ensure compliance.

8. Historical information

CPT 59855 was added to the Current Procedural Terminology system on January 1, 1995. The code underwent a change on January 1, 2010, with an updated description. In 2017, it was added to the Inpatient Only (IPO) list for Medicare.

9. Examples

1. A provider performs an induced abortion using vaginal suppositories and cervical dilation for a patient at 16 weeks gestation.
2. A patient at 18 weeks gestation undergoes an induced abortion using vaginal suppositories without cervical dilation.
3. A provider terminates a pregnancy at 22 weeks gestation using vaginal suppositories and dilation and evacuation.
4. A patient at 13 weeks gestation undergoes an induced abortion using vaginal suppositories and cervical dilation.
5. A provider performs an induced abortion using vaginal suppositories for a patient at 20 weeks gestation.
6. A patient at 15 weeks gestation undergoes an induced abortion using vaginal suppositories and cervical dilation.
7. A provider terminates a pregnancy at 23 weeks gestation using vaginal suppositories and dilation and evacuation.
8. A patient at 14 weeks gestation undergoes an induced abortion using vaginal suppositories without cervical dilation.
9. A provider performs an induced abortion using vaginal suppositories for a patient at 19 weeks gestation.
10. A patient at 12 weeks gestation undergoes an induced abortion using vaginal suppositories and cervical dilation.