CPT® Code 59821

1. Indications

The procedure described by CPT® Code 59821 is indicated for the following conditions:

• Missed Abortion A missed abortion occurs when the fetus has died in utero or is no longer developing but has not been expelled from the uterus. This condition necessitates surgical intervention to remove the retained tissue.
• Second Trimester Pregnancy The procedure specifically applies to cases of missed abortion that occur during the second trimester of pregnancy, where surgical treatment is required to manage the situation effectively.

2. Procedure

The surgical treatment for a missed abortion in the second trimester involves several key procedural steps:

• Preparation The patient is positioned appropriately, and a speculum is inserted into the vagina to allow for visualization of the cervix. The cervix is then cleansed with an antiseptic solution to reduce the risk of infection.
• Cervical Grasping The anterior cervical lip is grasped using a tenaculum, which helps stabilize the cervix during the procedure. This step is crucial for ensuring that the cervix remains in place while further interventions are performed.
• Cervical Dilation The cervix is numbed using a local anesthetic, and dilation is achieved by passing a series of metal rods of increasing diameter into the cervical canal. This gradual dilation is essential to prepare the cervix for the insertion of the suction curette.
• Laminaria Insertion (Optional) Alternatively, a laminaria tent may be inserted into the cervix 8-20 hours prior to the procedure. The laminaria absorbs moisture and swells, which helps to slowly dilate the cervical canal, making the surgical procedure easier and more effective.
• Suction Curettage A suction curette is then inserted through the cervix, and suction is initiated. The curette is rotated in a full circle several times to ensure that all products of conception are effectively removed from the uterus. This step is critical for the complete evacuation of retained tissue.
• Sharp Curettage (if necessary) In some cases, it may be necessary to follow the suction curettage with sharp curettage, which involves scraping the uterine lining to ensure that all products of conception have been removed. This step helps to prevent complications associated with retained tissue.
• Pathology Examination The tissue that has been removed is sent for pathology examination to confirm the diagnosis and rule out any other potential issues.
• Post-Procedure Care After the procedure, the tenaculum is removed, and any bleeding from the cervix is controlled with pressure to ensure patient safety and comfort.

3. Post-Procedure

Following the surgical treatment of a missed abortion, patients are typically monitored for any signs of complications, such as excessive bleeding or infection. It is important for patients to follow up with their healthcare provider to ensure proper recovery and to discuss any further care that may be needed. Patients may experience some cramping and bleeding as part of the recovery process, which is generally expected. However, any severe pain or heavy bleeding should be reported to a healthcare professional immediately. Additionally, patients may be advised on future pregnancy planning and any necessary emotional support following the procedure.