# History of Complicated Delivery



## Stefanie (Aug 12, 2010)

Our provider has scheduled a C-Section due to previous history of 4th degree perineal tear/laceration during delivery.  I can only find the V23.49 - Pregnancy with other poor obstetric history  or V23.9 - Other high-risk pregnancy.  Am I correct in using the V codes for this diagnosis?  Does anyone have another more specific code for this diagnosis.

Thank you.


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## bev519 (Aug 12, 2010)

Code 654.8_ is a better code.  We found it in a publication from another company, either the "OBGYN Coding Alert" or the "OBGYN Pink Sheet"...I'm not sure which.


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## Stefanie (Aug 12, 2010)

Thank you.  I was looking for something like that but couldn't find it.  Thanks again.


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## preserene (Aug 15, 2010)

Yes by the  terminology you may be right in assigning the code so -  previuos surgery to perineum/ vulva , even to anal sphincter.

But actually, the previous surgery was not alone a perineorraphy; it involved a surgery like a pelvic floor repair, even more  so in the sense it involved rectum and anus.

*654.73: * Why I place it on to *.7*  because the previous repair (surgery) involved not only perineum but also the whole depth of vagina, rectal mucosa and the anal sphincter during the 4th degree tear. 

The basic idea of the Physician contemplating for Elective  Cesarean , was this situation is to be considered and treated like a previous surgery of Pelvic Floor Repair/ surgery on the vagina and  the rectum(even more than that becuase of the ragged irregular edges of the tear), in which we do not contemplate leaving  her for vaginal delivery .  

Why the concern is because the whole of the pelvic floor muscles and rectum and the anus sphincter are at risk of tearing again, and, if you leave for vaginal delivery, the effect will be mostly devastating , not just the perineum  alone.  Hence I would place the code assignment to this* 654.7x / 73*.
May be you would have been paid with the code you said already. I do not blame that. But  what I suggested, would be the CORRECT code by all means.


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