# VBAC after previous VBAC



## AR2728 (Jul 13, 2010)

My physician wants to bill 59610 VBAC after cesarean for a VBAC she has performed on a patient who has had 4 previous VBACs.  CPT does not really clarify whether previous cesarean means immediately prior to the vaginal delivery. Does anyone have any guidelines on billing VBACs consecutively?


----------



## bonzaibex (Jul 13, 2010)

I think you can code the 59610--it is my understanding that once a patient has a cesarean, then the uterine scar poses a risk for subsequent vaginal birth attempts.  I believe this is a risk at each subsequent vaginal birth, not just at the immediate subsequent birth.  I don't have any guidelines or official advice to quote on this, though...

Becky, CPC


----------



## preserene (Jul 13, 2010)

This is really an interesting challenge in coding. Yes, your doctor is right in asking for 59610, so long as there is no separate listing for the VBAC after one previous1/2/3/4/ or 18 VBACs. 'FIRST CESAREAN, ALWAYS CESAREAN' kind of a phrase; "ONCE CESAREAN ALWAYS CARRIES THE LOAD OR BAGGAGE OF CESAREAN" !! but does not hold so always with the farmer phrase; and it is so much changing (changed), though.
Here  in this topic for discussion also, though VBAC after just immediate LSCS is a real trial labour, still with every VBAC following that immediate VBAC, the chances of risks, though, are decreasing with every other following VBAC ( just previous one cesarean complicating preg/labour, as the cause) yet not nullified. And more so with previous numbers of cesarean count ascends, ofcourse, the risks are more with following VBAC. 
More over, some of the management modelities are also 'always threat' with the previous cesarean, be it 1 or more. For eg, PGE2 pessary,syntocinon or any induction procedures on them. 

So,your doctor is perfectly right in asking  you to code 59610/59612. 
So as long as the Previous Cesarean label is there, the VBACs following, irrespective of previous numbers of VBACs following THE PREVIOUS Cesarean "being any-number -ahead'", the code will be 59610 or 59612( as the obstetric and postpartum care factor determines).
 keep me tuned in with the rules or from your experience if  this does not hold good.
Thank you


----------



## AR2728 (Jul 14, 2010)

Thanks for your assistance!  I agree and appreciate your advice.


----------



## jenniferlynnmetcalf (Oct 12, 2012)

Thank you all for this! Very helpful information.


----------

