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Question: What is the best CPT^® code for this case? 

Cesarean scar ectopic pregnancy at 8w3d. Patient comes for a planned uterine aspiration.

Procedure Performed: D&C.

Bedside sono notable for cesarean section scar pregnancy at beginning of procedure and thin EMS by the end.

The patient was taken to the OR with IV running and anesthesia was administered. They were placed in the dorsal lithotomy position and prepped and draped. An open-sided speculum was placed in the vagina and the cervix was cleaned with betadine. Cervical block with 20 mL of lidocaine 1% + 5 units vasopressin was administered and a tenaculum was placed on the anterior lip of the cervix. Abdominal ultrasound was placed and continued throughout the procedure. Dilation was performed with Pratt dilations to 25 French. The pregnancy was removed with 8 mm flexible cannula. Good hemostasis was noted after the procedure. All instruments were removed from the vagina and the patient was taken to the post-anesthesia recovery room awake and in stable condition. Products of conception were examined and noted to include chorionic villi and membrane.

Intraop Sono: Empty uterine cavity after the procedure.

I am thinking of 59820, because it’s like a failed pregnancy, molar pregnancy, blighted ovum, and demised fetus. Is that correct?

Tennessee Subscriber

Answer: The ectopic-specific codes involve cutting/excision, so 59820 (Treatment of missed abortion, completed surgically; first trimester) sounds correct since the ectopic was aspirated. You can also bill for the intraoperative ultrasound (76998, Ultrasonic guidance, intraoperative).

Suzanne Burmeister, BA, MPhil, Medical Writer and Editor