CPT® Code 59841

Official Description

Induced abortion, by dilation and evacuation

Common Language Description

An induced abortion, specifically by dilation and evacuation (D&E), is a medical procedure that involves the intentional termination of a pregnancy. This method is categorized as a therapeutic abortion, which is performed for various medical reasons. During the procedure, a healthcare provider utilizes a combination of techniques to safely remove the contents of the uterus. The process begins with the insertion of a speculum into the vagina to allow for a clear view of the cervix. The cervix is then cleansed with an antiseptic solution to minimize the risk of infection. A tenaculum, a surgical instrument, is used to grasp the anterior cervical lip, providing stability during the procedure. To assess the depth and angle of the uterus, a sound is passed through the cervix. This step is crucial for ensuring that the subsequent dilation is performed accurately. The cervix is numbed and dilated using a series of metal rods of increasing diameter, or alternatively, a laminaria tent may be placed in the cervix hours before the procedure to facilitate gradual dilation. Once the cervix is adequately dilated, a suction curette is inserted through the cervix. The suction is initiated while the curette is rotated, effectively removing the uterine contents. The procedure concludes with the removal of the tenaculum and the application of pressure to control any bleeding from the cervix. This method is recognized for its effectiveness and is a common approach in the context of induced abortions.

1. Indications

The procedure of induced abortion by dilation and evacuation (CPT® Code 59841) is indicated for various medical circumstances, including but not limited to:

Therapeutic Abortion - This procedure is performed when there are medical reasons necessitating the termination of a pregnancy.
Fetal Abnormalities - Indications may include cases where fetal anomalies are detected that are incompatible with life or would result in significant morbidity.
Maternal Health Risks - The procedure may be indicated when continuing the pregnancy poses a risk to the mother's physical or mental health.
Unintended Pregnancy - It is also indicated in situations where the pregnancy is unintended and the individual chooses to terminate it.

2. Procedure

The procedure for an induced abortion by dilation and evacuation involves several critical steps to ensure safety and effectiveness:

Step 1: Preparation - The patient is positioned appropriately, and a speculum is inserted into the vagina to provide visibility of the cervix. The cervix is then cleansed with an antiseptic solution to reduce the risk of infection.
Step 2: Cervical Stabilization - A tenaculum is used to grasp the anterior cervical lip, which stabilizes the cervix during the procedure.
Step 3: Uterine Assessment - A sound is passed through the cervix to determine the depth and angle of the uterus, which is essential for the subsequent dilation process.
Step 4: Cervical Dilation - The cervix is numbed, and dilation is achieved by inserting a series of metal rods of increasing diameter into the cervical canal. Alternatively, a laminaria tent may be placed in the cervix 8-20 hours prior to the procedure to facilitate gradual dilation.
Step 5: Suction Curettage - Once the cervix is adequately dilated, a suction curette is inserted through the cervix. Suction is initiated while the curette is rotated in a full circle several times to effectively remove the uterine contents.
Step 6: Completion - The procedure is considered complete when tissue and blood stop passing through the curette. The tenaculum is then removed, and any bleeding from the cervix is controlled with pressure.

3. Post-Procedure

After the dilation and evacuation procedure, patients are typically monitored for any immediate complications, such as excessive bleeding or signs of infection. It is important for the patient to receive instructions regarding post-procedure care, which may include recommendations for pain management, activity restrictions, and follow-up appointments to ensure proper recovery. Patients should also be informed about potential emotional responses following the procedure and provided with resources for counseling if needed.

Short Descr	INDUCED ABORTION DILAT&EVAC
Medium Descr	INDUCED ABORTION DILATION & EVACUATION
Long Descr	Induced abortion, by dilation and evacuation
Status Code	Restricted Coverage
Global Days	010 - Minor Procedure
PC/TC Indicator (26, TC)	0 - Physician Service Code
Multiple Procedures (51)	2 - Standard payment adjustment rules for multiple procedures apply.
Bilateral Surgery (50)	0 - 150% payment adjustment for bilateral procedures does NOT apply.
Physician Supervisions	09 - Concept does not apply.
Assistant Surgeon (80, 82)	0 - Payment restriction for assistants at surgery applies to this procedure...
Co-Surgeons (62)	0 - Co-surgeons not permitted for this procedure.
Team Surgery (66)	0 - Team surgeons not permitted for this procedure.
Diagnostic Imaging Family	99 - Concept Does Not Apply
APC Status Indicator	Hospital Part B services paid through a comprehensive APC
ASC Payment Indicator	Surgical procedure on ASC list in CY 2007; payment based on OPPS relative payment weight.
Type of Service (TOS)	2 - Surgery
Berenson-Eggers TOS (BETOS)	P5E - Ambulatory procedures - other
MUE	1
CCS Clinical Classification	126 - Abortion (termination of pregnancy)

22	Increased procedural services: when the work required to provide a service is substantially greater than typically required, it may be identified by adding modifier 22 to the usual procedure code. documentation must support the substantial additional work and the reason for the additional work (ie, increased intensity, time, technical difficulty of procedure, severity of patient's condition, physical and mental effort required). note: this modifier should not be appended to an e/m service.
82	Assistant surgeon (when qualified resident surgeon not available): the unavailability of a qualified resident surgeon is a prerequisite for use of modifier 82 appended to the usual procedure code number(s).
G7	Pregnancy resulted from rape or incest or pregnancy certified by physician as life threatening
GA	Waiver of liability statement issued as required by payer policy, individual case
GC	This service has been performed in part by a resident under the direction of a teaching physician
GY	Item or service statutorily excluded, does not meet the definition of any medicare benefit or, for non-medicare insurers, is not a contract benefit
Q6	Service furnished under a fee-for-time compensation arrangement by a substitute physician or by a substitute physical therapist furnishing outpatient physical therapy services in a health professional shortage area, a medically underserved area, or a rural area
SE	State and/or federally-funded programs/services
U4	Medicaid level of care 4, as defined by each state