Anesthesia Coding Alert

Question: The physician's notes about a 35-year-old obstetrical patient read, "G2P1, 38 6/7 weeks gestation; previous C/S procedure; repeat C/S. Epidural unsuccessful, GA given." Other notes mention a previous laparoscopy for endometriosis, a previous cesarean section, and a history of MVP and HNP. What do all these abbreviations mean, and what diagnosis applies?

Tennessee Subscriber Answer: First, G2P1 represents the patient's total number of pregnancies - gravida 2, para 1. That means the patient has had two pregnancies (gravida 2) with one live birth (para 1) prior to this one. The patient's current pregnancy brings this status to G2P2.
 
Acronyms are not always standard, but MVP is mitral valve prolapse, and HNP probably represents a history of herniated nucleus pulposa; this might be the reason the epidural failed. Don't code separately for it because it explains the use of general anesthesia rather than qualifies as a "complication."
 
A previous c-section code is sufficient justification for most carriers, so use that as your primary diagnosis
(654.21, Previous cesarean delivery; delivered, with or without mention of antepartum condition). Don't assign additional codes related to the patient's age unless the physician documents something supporting it such as 659.6x (Elderly multigravida) or 648.61 (Other cardiovascular diseases; delivered, with or without mention of antepartum condition).