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External cephalic version (ECV) is a medical procedure aimed at repositioning a fetus that is in a breech presentation to a vertex (head down) position prior to delivery. Breech presentation refers to the position of the fetus where the buttocks or feet are positioned to deliver first, rather than the head. There are several types of breech presentations, including frank breech, where the hips are flexed and knees are extended; complete breech, where both hips and knees are flexed; and footling breech, where one or both hips are extended with a foot presenting. The procedure is generally performed when the mother has reached at least 37 weeks of gestation, as this is closer to the time of delivery and allows for better fetal positioning. Prior to the ECV, a separate ultrasound is conducted to confirm the breech position of the fetus, assess the degree of engagement of the breech, evaluate the amount of amniotic fluid, identify the location of the placenta, and rule out any congenital anomalies or nuchal cord situations. Additionally, a non-stress test is performed to monitor the fetal heart rate for any abnormalities. If the physician determines that there are no contraindications, the procedure can proceed. During the ECV, an intravenous line is established, and a tocolytic agent may be administered to help suppress uterine contractions, facilitating the manipulation of the fetus. The mother is positioned either supine or in a slight Trendelenburg position to optimize the procedure's success. The physician then disengages the presenting part of the fetus and gently maneuvers the fetus into the desired vertex position using techniques such as a forward roll or back flip. If the initial attempt is unsuccessful, a back flip may be performed. After the procedure, the non-stress test is repeated to monitor for any signs of fetal distress or bradycardia, and a follow-up ultrasound is conducted to confirm whether the version was successful or not.
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External cephalic version (ECV) is indicated for the following conditions:
The procedure for external cephalic version involves several key steps:
Following the external cephalic version, the mother and fetus are closely monitored for any signs of complications. The non-stress test is repeated to ensure that the fetus is not in distress following the procedure. If the version is successful, the fetus is now in a vertex position, which is favorable for vaginal delivery. If the version is unsuccessful, the physician will discuss further options with the mother, which may include planning for a cesarean delivery if the breech presentation persists. It is important for the mother to be aware of any signs of complications, such as unusual pain or bleeding, and to follow up with her healthcare provider as needed.
| Short Descr | ANTEPARTUM MANIPULATION | Medium Descr | EXTERNAL CEPHALIC VERSION W/WO TOCOLYSIS | Long Descr | External cephalic version, with or without tocolysis | Status Code | Active Code | Global Days | MMM - Maternity Code | PC/TC Indicator (26, TC) | 0 - Physician Service Code | Multiple Procedures (51) | 0 - No payment adjustment rules for multiple procedures apply. | Bilateral Surgery (50) | 0 - 150% payment adjustment for bilateral procedures does NOT apply. | Physician Supervisions | 09 - Concept does not apply. | Assistant Surgeon (80, 82) | 0 - Payment restriction for assistants at surgery applies to this procedure... | Co-Surgeons (62) | 0 - Co-surgeons not permitted for this procedure. | Team Surgery (66) | 0 - Team surgeons not permitted for this procedure. | Diagnostic Imaging Family | 99 - Concept Does Not Apply | APC Status Indicator | Hospital Part B services paid through a comprehensive APC | ASC Payment Indicator | Non office-based surgical procedure added in CY 2008 or later; payment based on OPPS relative payment weight. | Type of Service (TOS) | 2 - Surgery | Berenson-Eggers TOS (BETOS) | P1G - Major procedure - Other | MUE | 1 | CCS Clinical Classification | 137 - Other procedures to assist delivery |
| 53 | Discontinued procedure: under certain circumstances, the physician or other qualified health care professional may elect to terminate a surgical or diagnostic procedure. due to extenuating circumstances or those that threaten the well being of the patient, it may be necessary to indicate that a surgical or diagnostic procedure was started but discontinued. this circumstance may be reported by adding modifier 53 to the code reported by the individual for the discontinued procedure. note: this modifier is not used to report the elective cancellation of a procedure prior to the patient's anesthesia induction and/or surgical preparation in the operating suite. for outpatient hospital/ambulatory surgery center (asc) reporting of a previously scheduled procedure/service that is partially reduced or cancelled as a result of extenuating circumstances or those that threaten the well being of the patient prior to or after administration of anesthesia, see modifiers 73 and 74 (see modifiers approved for asc hospital outpatient use). | 59 | Distinct procedural service: under certain circumstances, it may be necessary to indicate that a procedure or service was distinct or independent from other non-e/m services performed on the same day. modifier 59 is used to identify procedures/services, other than e/m services, that are not normally reported together, but are appropriate under the circumstances. documentation must support a different session, different procedure or surgery, different site or organ system, separate incision/excision, separate lesion, or separate injury (or area of injury in extensive injuries) not ordinarily encountered or performed on the same day by the same individual. however, when another already established modifier is appropriate it should be used rather than modifier 59. only if no more descriptive modifier is available, and the use of modifier 59 best explains the circumstances, should modifier 59 be used. note: modifier 59 should not be appended to an e/m service. to report a separate and distinct e/m service with a non-e/m service performed on the same date, see modifier 25. | 77 | Repeat procedure by another physician or other qualified health care professional: it may be necessary to indicate that a basic procedure or service was repeated by another physician or other qualified health care professional subsequent to the original procedure or service. this circumstance may be reported by adding modifier 77 to the repeated procedure or service. note: this modifier should not be appended to an e/m service. | 80 | Assistant surgeon: surgical assistant services may be identified by adding modifier 80 to the usual procedure number(s). | 81 | Minimum assistant surgeon: minimum surgical assistant services are identified by adding modifier 81 to the usual procedure number. | 82 | Assistant surgeon (when qualified resident surgeon not available): the unavailability of a qualified resident surgeon is a prerequisite for use of modifier 82 appended to the usual procedure code number(s). | GC | This service has been performed in part by a resident under the direction of a teaching physician |
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| 2002-01-01 | Changed | Code description changed. |
| Pre-1990 | Added | Code added. |
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