CPT® Code 59618

Routine obstetric care including antepartum care, cesarean delivery, and postpartum care, following attempted vaginal delivery after previous cesarean delivery

Routine obstetric care, as described by CPT® Code 59618, encompasses a comprehensive approach to managing a pregnancy that includes antepartum care, cesarean delivery, and postpartum care, specifically following an attempted vaginal delivery after a previous cesarean section. This scenario is often referred to as a cesarean delivery following a failed trial of labor or a failed vaginal birth after cesarean (failed VBAC). The procedure begins with the physician conducting routine prenatal office visits, which involve an initial maternal history assessment and evaluation of both the mother's and fetus's health status. These visits are structured to occur monthly during the first 28 weeks of gestation, transitioning to biweekly visits until 36 weeks, and then weekly visits as the delivery date approaches. In the event of a failed trial of labor, the patient is promptly transferred to the surgical suite where an anesthetic, such as an epidural, is administered to ensure comfort during the procedure. The surgical process involves making an incision in the abdomen, followed by an incision in the uterus to access the amniotic fluid, which is then suctioned out. Given that the baby’s head is likely engaged in the pelvis due to the attempted vaginal delivery, the physician first disengages the head before delivering it through the uterine incision. After the head is delivered, the physician clears the baby's airways by suctioning. The baby is then fully removed from the uterus, while the physician remains vigilant for any complications, such as umbilical cord entanglement. Once the baby is delivered, it is shown to the parents and placed in a warmer for examination and care by other medical staff. Following the delivery, the placenta is also removed and examined by the physician. The final steps of the procedure involve closing the uterine incision and the abdominal layers. Post-delivery, the physician continues to provide care for the patient during her hospital stay and ensures follow-up care in the office after the cesarean delivery. The use of CPT® Code 59618 is appropriate when all components of antepartum care, cesarean delivery following a failed VBAC, and postpartum care are provided. For instances where only the cesarean delivery is performed, CPT® Code 59620 should be used, and for cases involving cesarean delivery and postpartum care, CPT® Code 59622 is applicable.