CPT® Code 59857

1. Indications

The procedure described by CPT® Code 59857 is indicated for the termination of pregnancy when medical evacuation has failed. The following conditions may warrant this procedure:

• Failed Medical Abortion The procedure is performed when an initial attempt at medical abortion using pharmacological agents has not successfully terminated the pregnancy.
• Second Trimester Abortion This procedure is particularly indicated for pregnancies in the second trimester, where cervical dilation may be necessary to facilitate the abortion process.

2. Procedure

The procedure for CPT® Code 59857 involves several critical steps to ensure the safe and effective termination of pregnancy. Each step is outlined as follows:

• Step 1: Hospital Admission The patient is admitted to the hospital for monitoring and management throughout the abortion process. This ensures that the healthcare team can provide immediate care and support as needed.
• Step 2: Cervical Dilation If the abortion is being performed in the second trimester, passive cervical dilators, such as laminaria or a balloon catheter, may be inserted into the cervix to facilitate dilation. This step is crucial for preparing the cervix for the subsequent administration of vaginal suppositories.
• Step 3: Administration of Vaginal Suppositories One or more vaginal suppositories, typically containing prostaglandin, are inserted into the vaginal fornix. Prostaglandin is a potent substance that helps to soften the cervix and stimulate uterine contractions, thereby aiding in the abortion process.
• Step 4: Monitoring Throughout the procedure, uterine and fetal activity is closely monitored, along with the vital signs of the mother. This monitoring is essential to assess the effectiveness of the medication and the overall health of the patient.
• Step 5: Additional Suppositories If necessary, additional vaginal suppositories may be administered at intervals of 6 to 12 hours to enhance the effectiveness of the procedure and ensure adequate uterine contractions.
• Step 6: Hysterotomy If it becomes evident that the medical evacuation has failed, a hysterotomy is performed. This surgical step involves making an incision in the abdomen to access the uterus, which is then incised to allow for the removal of the fetus and placenta.
• Step 7: Removal of Fetus and Placenta The physician carefully removes the fetus and placenta from the uterus. Following removal, the placenta is examined, and the uterus is inspected to confirm that all products of conception have been successfully extracted.
• Step 8: Closure After ensuring that the uterus is clear, the uterine incision is closed, and the abdominal layers are closed in a layered fashion to promote proper healing.

3. Post-Procedure

Post-procedure care following the induced abortion is critical for the patient's recovery. Patients are typically monitored for any signs of complications, such as excessive bleeding or infection. Follow-up visits may be scheduled to ensure that the patient is healing properly and to address any ongoing health concerns. It is also important for healthcare providers to offer emotional support and counseling, as the experience of an abortion can be significant for many patients. Patients are advised to follow specific post-operative instructions regarding activity levels, signs of complications to watch for, and when to seek further medical attention.