|MP 4.01.08||External Cephalic Version|
|Original Policy Date
|Last Review Status/Date
Review by consensus/2:2003
|Return to Medical Policy Index|
Our medical policies are designed for informational purposes only and are not an authorization, or an explanation of benefits, or a contract. Receipt of benefits is subject to satisfaction of all terms and conditions of the coverage. Medical technology is constantly changing, and we reserve the right to review and update our policies periodically.
External version is the method of turning the fetus in the uterus to avoid a breech delivery. An intravenous infusion of ritodrine, a drug used to relax the uterus, is used during the external version to reduce complications associated with external cephalic version.
External version is considered medically necessary to avoid a breech delivery.
No applicable information
BlueCard/National Account Issues
External version may be included as an integral part of the global obstetrical fee. It is not to be billed as a separate procedure.
A search of literature was completed through the MEDLINE database for the period of January 1992 through December 1995. The search strategy focused on references containing the following Medical Subject Headings:
Research was limited to English-language journals on humans.
|CPT||59412||External cephalic version, with or without tocolysis|
|ICD-9 Procedure||73.91||External version|
|ICD-9 Diagnosis||652.10–652.13||Breech or other malpresentation successfully converted to cephalic presentation code range|
|Type of Service||OB/GYN|
|Place of Service||Inpatient
External cephalic version
Version, external cephalic
|3/31/96||Add to OB/Gyn section||New policy|
|7/12/02||Replace policy||Policy reviewed by consensus; new review date only|
|07/17/03||Replace policy||Policy no longer scheduled for review|