abortions DX code - 635, 636,637 series

Abortions

On an annual basis, the number of legal, elective, or therapeutic, and illegal abortions that are performed in DoD MTFs must be reported to Congress.  Use of the 635, 636 and 637 codes should be carefully scrutinized.  Do not use 635-638 unless you received authorization from your Service coding representative.  Some of the basic rules that apply include the following:

•    Fifth-digit-1, incomplete, indicates that all of the products of conception have not been expelled from the uterus prior to the episode of care. 
•    Fifth-digit-2, complete, indicates that all of the products of conception have been expelled from the uterus. 
•    Code 635 requires additional code to identify the reason for the abortion.  Codes from categories 640-648 and 651-657 (with fifth digits “3”) may be used as additional codes with an abortion code to indicate the complication leading to the abortion.
•    Codes from the 660-669 series are not to be used for complication leading to the abortion.
•    Category code 639 will be used for all complications following abortions.  Code 639 cannot be assigned in the presences of codes 634-638.
•    Retained Products of Conception following an abortion:  Subsequent encounters with the diagnosis of retained products of conception following a spontaneous or legally induced abortion are assigned the appropriate code from category 634, spontaneous abortion, or 635, legally induced abortion, with a fifth digit of 1 (incomplete).  This advice is appropriate even when the patient was discharged previously with a diagnosis of complete abortion.
•    Illegally Induced Abortion (636):  Not performed within prescribed statutes, performed by an unqualified individual, or performed at an unauthorized location.  This code would only be used if someone were performing illegal abortions at your facility.  When a patient has an illegal abortion performed outside the MTF, and presents for treatment to ensure the abortion is complete or to treat a complication, code the complications using 639x codes, the aftercare codes in V58x or the follow-up codes in V67x as applicable. 
•    Unspecified Abortion (637):  No details about the abortion are available. 
•    Failed Abortion (638):  One in which the elective procedure failed to evacuate or expel the products of conception (fetus) and the patient is still pregnant. 

As with all coding, it is important to select the correct 3rd, 4th, and 5th digits, as applicable.  Use DoD-unique code extenders 0 (elective), 1 (therapeutic), or 9 (unspecified) with abortion codes 635 and 638.

When using the codes for abortions, incomplete with other specified complications, an additional code is required to describe the “other specified complication.”

If an abortion was performed at the MTF or elsewhere, and the patient returns for follow-up care after the abortion, and no problem is present, then code V67.09 Follow-up exam following surgery.