Routine incision closure at cesarean delivery

Read an original fictional chart, identify the supported facts, and explain your coding workflow.

Chart gym · Original fictional record

Service date: 2026-09-09 · Hospital maternity admission; professional claim; 2026 Medicare NCCI relationship

Use your code books and write your reasoning before opening the walkthrough. This exercise contains no real patient information.

Care responsibility

Synthetic patient at 39 weeks is admitted for a planned primary cesarean delivery for persistent breech presentation. The practice furnished delivery care only; another practice provided routine prenatal care. The exercise concerns the closure relationship for the supported 2026 delivery procedure, not the total obstetric package.

Operative record

The surgeon completes a low-transverse cesarean delivery through a transverse lower-abdominal incision. The uterus and fascia are closed, the subcutaneous tissue is approximated, and the skin is closed with suture. There is no separate traumatic wound or later return to surgery.

Clinical documentation

The operative note records a 14 cm skin incision and the closure materials. These are details of the same cesarean incision. The clinical documentation remains part of the record even though routine operative closure is included.

Proposed addition

A worksheet adds a skin-repair procedure based on incision length and the number of layers. Review the NCCI instruction for closure of a surgical incision with the maternity global indicator. The supplied service is the 2026 delivery procedure; do not invent a separate traumatic wound.

Your coding worksheet

Identify whether the wound is the operative incision.
Distinguish routine closure from a separate traumatic repair.
Evaluate the length-based additional procedure.
Keep the service year and maternity relationship explicit.

In your notebook, record the supported facts, your index route, the instructions you checked, and any missing detail that limits your answer.

Compare with the worked explanation

The wound is the incision created for the cesarean operation.
No separately documented traumatic wound is supplied.
NCCI G.5 includes the routine surgical incision closure in the stated maternity relationship; length and layers do not establish an additional repair.
Use the appropriate 2026 delivery-only service supported by the stated care responsibility. The routine closure does not create an additional repair.

Reference sections: G.5

Practice the linked chart questions