Suction D&C (Uterine Aspiration)
5982059812wRVU: 4.33 — Treatment of incomplete abortion, any trimester, completed surgically (standalone primary code, not an add-on to 59820; 4.33 wRVU, 90-day global)59821wRVU: 4.96 — Treatment of missed abortion, completed surgically, second trimester (standalone primary; 4.96 wRVU, 90-day global)59160wRVU: 2.69 — Curettage postpartum for retained products after delivery (standalone primary; 2.69 wRVU, 10-day global)59870wRVU: 6.41 — Uterine evacuation and curettage for hydatidiform mole (standalone primary; 6.41 wRVU, 90-day global)
[Missed abortion / incomplete abortion / retained products of conception / molar pregnancy] at [X] weeks gestation
Same
Suction dilation and curettage (uterine aspiration) [manual vacuum aspiration / electric vacuum aspiration]
[***, MD/DO]
[Nurse/tech name]
[Paracervical block with IV sedation / MAC / general]
The patient is a [age]-year-old [gravida X, para Y] female at [X] weeks gestation with [a missed abortion / an incomplete abortion / retained products of conception] confirmed by [ultrasound / clinical examination]. Expectant, medical, and surgical management were discussed, and the patient elected surgical uterine evacuation. The risks, benefits, and alternatives were reviewed and informed consent was obtained. Rh status was [positive / negative], with anti-D immune globulin planned for the Rh-negative patient.
The cervix was [closed / dilated / open with tissue at the os]. The uterus was [anteverted / retroverted] and sized to approximately [X] weeks. A [X]-mm cannula was selected to match the gestational age. [Scant / moderate / abundant] products of conception were obtained, and villi were [identified / not identified] on gross inspection. The uterine cavity was empty and firm at the end of the procedure.
The patient was positioned in the dorsal lithotomy position and the external genitalia and vagina were prepped and draped. Prophylactic [doxycycline] was administered. A [weighted speculum] was placed and the anterior cervical lip was grasped with a [single-tooth tenaculum]. A paracervical block was placed with [10-20 mL of 1% lidocaine] where used.
Routine sounding was deferred to limit the risk of perforation in the gravid uterus. The cervix was gently dilated as needed with [Hegar / Pratt] dilators to admit a [X]-mm cannula sized to the gestational age. A [manual vacuum aspirator / electric suction] cannula was advanced to the fundus, withdrawn slightly, and the cavity was evacuated with rotation and gentle passes until a gritty sensation and pink frothy aspirate signaled complete evacuation. [A gentle sharp curette pass confirmed the cavity was empty.] Suction was reapplied briefly to clear residual tissue.
The products of conception were inspected grossly to confirm the expected volume of villous tissue. [If villi were not confirmed, an ectopic pregnancy or gestational trophoblastic disease was excluded before disposition.] The uterus was firm with minimal bleeding. The tenaculum was removed and cervical hemostasis was confirmed. Anti-D immune globulin was administered for the Rh-negative patient.
None [/ incomplete evacuation, uterine perforation, cervical laceration, hemorrhage managed with uterotonics]
Products of conception, sent to pathology [and cytogenetics if indicated]
Minimal
None
The patient tolerated the procedure well and was taken to the PACU in stable condition. Anti-D immune globulin was given for the Rh-negative patient. The patient was discharged the same day with return precautions for heavy bleeding, fever, or pain.
Epic SmartPhrase Version
PREOPERATIVE DIAGNOSIS: *** at *** weeks
POSTOPERATIVE DIAGNOSIS: Same
PROCEDURE PERFORMED: Suction D&C (uterine aspiration), [MVA / electric]
ATTENDING: ***, MD/DO
ASSISTANT: ***
ANESTHESIA: Paracervical block/MAC
INDICATIONS: .PTAGE-year-old .PTSEX at *** weeks with ***. Expectant, medical, and surgical options discussed; patient elected surgical evacuation. Consent obtained. Rh ***; anti-D planned if Rh-negative.
FINDINGS: Cervix ***. Uterus *** sized to *** weeks. *** mm cannula. *** products of conception; villi ***. Cavity empty and firm.
PROCEDURE:
Lithotomy. Prepped and draped. Prophylactic doxycycline. Weighted speculum, tenaculum on the anterior lip. Paracervical block. Routine sounding deferred given the gravid uterus. Gentle dilation to admit a *** mm cannula sized to gestational age. Cavity evacuated by *** vacuum aspiration with rotation until a gritty sensation and pink frothy aspirate were obtained. Products inspected and villi confirmed. Uterus firm and hemostatic. Anti-D given if Rh-negative.
EBL: Minimal
SPECIMENS: Products of conception to pathology
COMPLICATIONS: None
DISPOSITION: Same-day discharge with return precautions.
Signed: .ME, .MYDEGREE
.TODAYVariants
Postpartum Retained Products (D&C After Delivery)
For retained products after a [vaginal / cesarean] delivery, curettage was performed for postpartum hemorrhage or retained placenta. Ultrasound guidance was used where available to limit the perforation risk in the soft postpartum uterus. A large blunt (banjo) curette or suction was used to clear retained tissue until the cavity was empty and the uterus contracted, and uterotonics were given to maintain tone. This scenario bills as 59160, not the 598xx miscarriage codes.
Molar Pregnancy (Suction Evacuation)
For a hydatidiform mole, suction evacuation was performed with a large-bore cannula, with oxytocin started after cervical dilation to reduce bleeding and the risk of trophoblastic embolization. The characteristic hydropic vesicular tissue was evacuated and sent to pathology, and a gentle sharp curettage completed the evacuation. A baseline quantitative hCG was obtained and serial hCG surveillance was arranged. This scenario bills as 59870.
Charting Tips
- For a first-trimester loss, vacuum aspiration (manual or electric) is the preferred technique; sharp curettage alone is no longer recommended as the primary method and carries a higher injury risk. Document that suction was used, and reserve any sharp curettage for a confirmatory pass.
- Chart that routine pre-procedure sounding was deferred. The gravid uterus is soft and the perforation risk is higher, so many operators dilate and aspirate under tactile and, when available, ultrasound guidance rather than sounding first.
- Document Rh status and, for the Rh-negative patient, administration of anti-D immune globulin (50 mcg in the first trimester, 300 mcg later). Uterine evacuation is a sensitizing event, and omitting anti-D is a preventable cause of alloimmunization.
- Confirm complete evacuation and describe the products of conception. If the expected villi are not seen on gross inspection, document the plan to exclude an ectopic pregnancy or gestational trophoblastic disease with quantitative hCG and pathology.
- Document any prophylactic antibiotic given. Peri-procedural antibiotics lower the rate of post-procedure pelvic infection after uterine aspiration.
- For nonpregnant diagnostic dilation and curettage (abnormal or postmenopausal bleeding, endometrial sampling), use the Dilation and Curettage note instead.
Billing Tips
- Bill 59820 for surgical treatment of a first-trimester missed abortion (4.72 wRVU, 90-day global). Use for evacuation of a nonviable intrauterine pregnancy before the end of the first trimester.
- Bill 59812 for surgical completion of an incomplete abortion, any trimester (4.33 wRVU, 90-day global), and 59821 for a second-trimester missed abortion (4.96 wRVU). Choose the code by the clinical scenario, not by the instrument used.
- These 598xx codes carry a 90-day global period, unlike nonobstetric D&C (58120, 10-day). Routine follow-up within 90 days is bundled; a return to the OR for retained tissue uses modifier -58 when planned or -78 for an unplanned complication.
- Bill 59160 for curettage of retained products after a delivery (2.69 wRVU, 10-day global). This is distinct from the 598xx miscarriage codes and from nonobstetric 58120.
- Bill 59870 for suction evacuation and curettage of a hydatidiform mole (6.41 wRVU, 90-day global). Document the molar diagnosis, quantitative hCG, and the plan for serial hCG surveillance.
- Do not bill 58120 (nonobstetric D&C) for any pregnancy-related evacuation. The pregnancy-specific code already includes the dilation and evacuation.
General coding reference. Verify with your institution’s billing department before submitting claims.