Summary & Overview
CPT 59821: Surgical Management of Intrauterine Fetal Demise, 14–28 Weeks
CPT code 59821 denotes surgical removal of a fetus and all products of conception via a vaginal approach after confirmation of fetal death in utero between 14 weeks 0 days and less than 28 weeks 0 days of gestation. This code captures second-trimester surgical management of intrauterine fetal demise and is used for billing and policy determinations tied to obstetric surgical care. Nationally, accurate coding of this service affects hospital obstetric unit workflows, payer coverage determinations, and maternal health quality measurement.
Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of clinical context and service setting, typical billing considerations, and the types of benchmarks and policy topics relevant to this procedure. The publication summarizes common payer coverage patterns and reimbursement considerations, highlights coding and billing nuances specific to second-trimester surgical management of fetal demise, and outlines areas where clinical documentation and facility site selection commonly affect claims processing.
This national-level summary is intended to inform billing staff, compliance officers, clinical coders, and policy analysts about the clinical definition and operational implications of CPT code 59821, including where further detail or payer-specific policy review may be needed.
Billing Code Overview
CPT code 59821 describes a surgical procedure in which the provider confirms fetal death in utero between 14 weeks 0 days and less than 28 weeks 0 days' gestation and removes the fetus and all products of conception via a vaginal approach. This procedure is a second-trimester surgical management of intrauterine fetal demise.
-
Service type: Surgical management of fetal demise (vaginal uterine evacuation)
-
Typical site of service: Hospital operating room, labor and delivery unit, or an ambulatory surgical center depending on clinical circumstances and facility resources
Data not available in the input.
Clinical & Coding Specifications
Clinical Context
A 22-week gestational patient presents to the labor and delivery unit after ultrasound confirms intrauterine fetal demise. The patient has vaginal bleeding and cramping; the obstetric provider evaluates maternal hemodynamic stability, obtains informed consent, reviews prior deliveries and anesthesia options, and discusses risks including infection and hemorrhage. Pre-procedure documentation includes gestational age confirmation (≥14w0d to <28w0d), fetal demise documentation, relevant labs (CBC, type and screen), and review of prior surgical or obstetric history. The procedure is performed in a hospital labor and delivery or ambulatory surgical unit under regional or general anesthesia as indicated. The provider performs a surgical vaginal delivery of the fetus and removal of products of conception using standard obstetric technique (e.g., dilation and curettage or operative vaginal delivery as clinically appropriate). Post-procedure care includes uterine tone assessment, hemorrhage monitoring, pain control, Rh immune globulin administration if indicated, counseling, and documentation of surgical findings and estimated blood loss in the operative note.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
11 | Primary procedure | When this is the principal procedure performed during the encounter |
22 |