2025 CPT code 59612

Vaginal delivery only, after a previous Cesarean delivery, with or without episiotomy and/or forceps.

Follow current CPT coding guidelines for obstetrical services and the specific guidelines provided for VBAC deliveries.

Modifier 22 (Increased procedural service) may be added if the provider's work exceeds normal effort, supported by thorough documentation.Other modifiers may apply depending on the specific circumstances of the procedure.

Medical necessity is established by the presence of a previous Cesarean delivery and the attempt at a vaginal birth. Documentation should justify the use of forceps or episiotomy if utilized.

The physician manages labor, performs the delivery, provides immediate postpartum care, and may consult with other specialists (anesthesiologists, operating room staff, neonatologists/pediatricians).

IMPORTANT Codes 59610-59622 are used for patients with a prior Cesarean delivery expecting vaginal delivery.If the VBAC is successful, use 59610-59614. If unsuccessful and a Cesarean is performed, use 59618-59622.Elective Cesarean deliveries use codes 59510, 59514, or 59515.For delivery-only services, use codes 59409, 59514, 59612, or 59620, and report inpatient post-delivery management with E/M codes 99238, 99239.Delivery and postpartum services (59410, 59515, 59614, 59622) include inpatient and outpatient postpartum care.

In simple words: This code covers a vaginal delivery after a woman has had a previous Cesarean birth. It includes the care during labor, the actual delivery, and immediate care after delivery.This is all on the same day.

This CPT code reports a vaginal delivery following a prior Cesarean section.It includes the intrapartum care, which begins with the patient's arrival at the hospital or notification of labor, encompassing initial assessments, fetal monitoring, labor management, and potential interventions such as the use of low forceps or episiotomy. The procedure culminates in the vaginal delivery of the fetus and placenta, followed by immediate postpartum care on the same day.The code encompasses all services provided during the process.

Example 1: A patient with a prior Cesarean delivery attempts a vaginal delivery. Labor is managed, low forceps are used, and an episiotomy is performed. The vaginal delivery is successful. , A patient presents for a VBAC. The patient progresses to full dilation but requires significant assistance with low forceps. An episiotomy is performed., A patient experiences a difficult labor requiring close monitoring and interventions. After a prolonged attempt at vaginal delivery, a Cesarean is necessary.

Detailed documentation of the labor and delivery process, including fetal monitoring, interventions (forceps, episiotomy), complications, and postpartum care.

** This code does not include antepartum or postpartum care beyond immediate post-delivery care on the day of the delivery.Separate codes are used for these services.Always refer to the most current CPT codebook and guidelines for accurate coding.

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