CPT® Code 59412

External cephalic version (ECV) is a medical procedure aimed at repositioning a fetus that is in a breech presentation to a vertex (head down) position prior to delivery. Breech presentation refers to the position of the fetus where the buttocks or feet are positioned to deliver first, rather than the head. There are several types of breech presentations, including frank breech, where the hips are flexed and knees are extended; complete breech, where both hips and knees are flexed; and footling breech, where one or both hips are extended with a foot presenting. The procedure is generally performed when the mother has reached at least 37 weeks of gestation, as this is closer to the time of delivery and allows for better fetal positioning. Prior to the ECV, a separate ultrasound is conducted to confirm the breech position of the fetus, assess the degree of engagement of the breech, evaluate the amount of amniotic fluid, identify the location of the placenta, and rule out any congenital anomalies or nuchal cord situations. Additionally, a non-stress test is performed to monitor the fetal heart rate for any abnormalities. If the physician determines that there are no contraindications, the procedure can proceed. During the ECV, an intravenous line is established, and a tocolytic agent may be administered to help suppress uterine contractions, facilitating the manipulation of the fetus. The mother is positioned either supine or in a slight Trendelenburg position to optimize the procedure's success. The physician then disengages the presenting part of the fetus and gently maneuvers the fetus into the desired vertex position using techniques such as a forward roll or back flip. If the initial attempt is unsuccessful, a back flip may be performed. After the procedure, the non-stress test is repeated to monitor for any signs of fetal distress or bradycardia, and a follow-up ultrasound is conducted to confirm whether the version was successful or not.