Ob-Gyn Coding Alert

Question: What does -failure to descend- mean? How should I code it? Also, what is prolonged labor? My ob-gyn simply wrote -prolonged labor 2.5 hours.- How should I code that?

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Answer: If the patient reaches full dilation and pushes for two or more hours and the baby's head has not moved down into the birth canal (for whatever reason), ob-gyns call this -failure to descend.-

The reasons for failure of descent can be a large baby, an umbilical cord problem, deflexed head, cephalopelvic disorder (CPD) and so on.

Bottom line: To code this condition properly, you need to know the reason for the failure to descend. In the absence of any information, you-re limited to 661.91 (Unspecified abnormality of labor; delivered, with or without mention of antepartum condition).

The American College of Obstetricians and Gynecologists (ACOG) defines prolonged labor as active labor that continues longer than 20 hours.

Consequently, you should not consider 2.5 hours as prolonged labor. In fact, the average duration of the latent labor phase (first stage) in a primigravida is 6.4 hours and in the multigravida phase, 4.8 hours, but if this phase goes beyond 24 hours, you can consider this prolonged.

The normal length of the second labor stage is no more than four hours, so you would consider anything beyond that as prolonged labor. So again, you cannot code this condition unless you know if the patient is in the first or second stage.

In other words, if all the physician writes is -prolonged labor 2.5 hours,- you do not have enough information to use even the unspecified code (662.11, Prolonged labor, unspecified; delivered, with or without mention of antepartum condition).