Cesarean Section Births

CPT Coding
Cassandra Booe

A cesarean delivery is a birth through an incision in the abdominal wall and uterus rather
than through the vagina. According to the CDC, more than 1 out of 4 women go through a
cesarean delivery. There are many different medical reasons as to why a woman may have to
undergo a cesarean section delivery as opposed to a vaginal delivery.
Some cesarean deliveries are a result of a critical situation, to avoid a critical situation,
and some are elective. Some of the medical reasons for a cesarean delivery include: complete or
partial placenta previa which is when the placenta lies low in the uterus and covers the cervix;
placental abruption which is when the placenta separates from the uterine wall which can cause
oxygen deprivation for the fetus; uterine rupture; breach position; cord prolapse which happens
when the umbilical cord slips through the cervix and protrudes from the vagina before the baby
is born; fetal distress; failure to progress in labor; repeat cesarean; cephalopelvic disproportion
(CPD) which is when the babys head is too large or the mothers pelvis is too small to allow the
baby to pass through; active genital herpes; diabetes; preeclampsia; birth defects and; multiple
births.
The global fee payment method is increasing the amounts of cesarean deliveries because
it provides an incentive for providers who perform them and is a faster more efficient form of
delivery for the facility. The flat global fee method of paying for childbirth does not provide
any extra pay for providers who patiently support a longer vaginal birth. Some payment
schedules actually pay higher rates for cesarean births than vaginal births. Additionally, a
planned cesarean section is more efficient for providers because it allows for a planned and
quicker birth and allows for them to organize their hospital and office work.

Cesarean Section Births

CPT Coding
Cassandra Booe

Physicians may not allow a woman to have a vaginal birth after a previous cesarean
(VBAC) if there are certain risks involved that would put the mother and, or baby in danger. The
biggest risk in a VBAC is uterine rupture, which happens in 0.2-1.5% of VBACs. Certain criteria
must be met in order to have a vaginal birth after a cesarean section has previously been
performed. Around 90% of women are still candidates for a vaginal birth for their next birth after
a previous cesarean section. There are several labor interventions that make cesarean birth more
likely. Labor induction among first-time mothers and/or when the cervix is not soft and ready to
open increases the likelihood of a cesarean birth. Also, continuous electronic fetal monitoring
seems to increase the likelihood. Administering of an epidural without a high-dose boost of
synthetic oxytocin is also a contributing factor to a cesarean delivery. Finally, epidural analgesia
when performed in response to fetal distress and lying in bed during labor as opposed to sitting
upright or walking also seems to increase the chances of a cesarean delivery.

Cesarean Section Births

CPT Coding
Cassandra Booe

Resources:
American Pregnancy Association. (2015). Reasons for a cesarean birth.
http://americanpregnancy.org/labor-and-birth/reasons-for-a-cesarean/
Childbirth Connection. (2015). Cesarean section.
http://www.childbirthconnection.org/article.asp?ck=10456