CODING FOR MEDICATION ABORTION USING MIFEPRISTONE (MIFEPREX)
Medication abortion using mifepristone (and misoprostol) involves 2 office visits, lab tests, ultrasounds, and administration of medication. The following codes can be used when providing these services:
2 VISIT PROTOCOL
Includes verification of pregnancy and pregnancy date, counseling of the patient, and administration of mifepristone.
Diagnosis code 635.92 (legally induced abortion, without mention of complication, complete). Please check ICD-9 manual for other codes for abortion with complications). Five-digit diagnosis code needed.
CPT Code for Visit
99204 or 99214 (level 4 new or established patient E/M visit)
Code for Medication (Each insurance carrier may reimburse for Mifeprex using a different code).
J8499 (prescription drug, oral, nonchemo, not otherwise specified) or
J3490 (unclassified drug).
If J codes not accepted by insurance carrier, use 99070 (a cost of materials CPT code) for Mifepristone or S0190 for Mifepristone.
The name of the drug (Mifepristone), the dosage (200mg.), and the 11-digit national drug code (NDC) from the drug package must accompany this claim. In addition, submit a copy of the drug invoice to show the cost of the drug.
CPT Code for Sonography
76817 (transvaginal ultrasound, pregnant uterus) or 76815 (limited ultrasound, pregnant uterus)
Lab Tests In addition, submit codes for appropriate lab tests or Micro Rhogham (90385) if done in office
Includes verification that the pregnancy has ended.
Diagnosis Code 635.92
CPT Code for Visit 99213 or 99214 (level 3 or 4 E/M visit for established patient)
CPT Code for Sonography 76817 or 76815 (ultrasound)