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Luteal phase defect may warrant 2nd code
You might also consider adding a second code to further clarify the reason for the visit. For instance, evaluation for this problem may be related to infertility or recurrent spontaneous abortions.
If the patient miscarries frequently, let the payer know that the visit was not related to infertility by adding the code V13.29 (personal history of other genital system and obstetric disorders) or 629.9 (habitual aborter without current pregnancy).
Ms. Witt, former program manager in the Department of Coding and Nomenclature at the American College of Obstetricians and Gynecologists, is an independent coding and documentation consultant. Reimbursement Adviser reflects the most commonly accepted interpretations of CPT-4 and ICD-9-CM coding. When in doubt on a coding or billing matter, check with your individual payer.
You might also consider adding a second code to further clarify the reason for the visit. For instance, evaluation for this problem may be related to infertility or recurrent spontaneous abortions.
If the patient miscarries frequently, let the payer know that the visit was not related to infertility by adding the code V13.29 (personal history of other genital system and obstetric disorders) or 629.9 (habitual aborter without current pregnancy).
Ms. Witt, former program manager in the Department of Coding and Nomenclature at the American College of Obstetricians and Gynecologists, is an independent coding and documentation consultant. Reimbursement Adviser reflects the most commonly accepted interpretations of CPT-4 and ICD-9-CM coding. When in doubt on a coding or billing matter, check with your individual payer.
You might also consider adding a second code to further clarify the reason for the visit. For instance, evaluation for this problem may be related to infertility or recurrent spontaneous abortions.
If the patient miscarries frequently, let the payer know that the visit was not related to infertility by adding the code V13.29 (personal history of other genital system and obstetric disorders) or 629.9 (habitual aborter without current pregnancy).
Ms. Witt, former program manager in the Department of Coding and Nomenclature at the American College of Obstetricians and Gynecologists, is an independent coding and documentation consultant. Reimbursement Adviser reflects the most commonly accepted interpretations of CPT-4 and ICD-9-CM coding. When in doubt on a coding or billing matter, check with your individual payer.
Mesh is an internal graft for coding purposes
If there was evidence of infection or inflammation, the correct code would be 996.65, specific for a genitourinary device, implant, or graft.
If there was evidence of pain, fibrosis, stenosis, hemorrhage, or erosion, the diagnosis specific to a genitourinary device would be 996.76.
Ms. Witt, former program manager in the Department of Coding and Nomenclature at the American College of Obstetricians and Gynecologists, is an independent coding and documentation consultant. Reimbursement Adviser reflects the most commonly accepted interpretations of CPT-4 and ICD-9-CM coding. When in doubt on a coding or billing matter, check with your individual payer.
If there was evidence of infection or inflammation, the correct code would be 996.65, specific for a genitourinary device, implant, or graft.
If there was evidence of pain, fibrosis, stenosis, hemorrhage, or erosion, the diagnosis specific to a genitourinary device would be 996.76.
Ms. Witt, former program manager in the Department of Coding and Nomenclature at the American College of Obstetricians and Gynecologists, is an independent coding and documentation consultant. Reimbursement Adviser reflects the most commonly accepted interpretations of CPT-4 and ICD-9-CM coding. When in doubt on a coding or billing matter, check with your individual payer.
If there was evidence of infection or inflammation, the correct code would be 996.65, specific for a genitourinary device, implant, or graft.
If there was evidence of pain, fibrosis, stenosis, hemorrhage, or erosion, the diagnosis specific to a genitourinary device would be 996.76.
Ms. Witt, former program manager in the Department of Coding and Nomenclature at the American College of Obstetricians and Gynecologists, is an independent coding and documentation consultant. Reimbursement Adviser reflects the most commonly accepted interpretations of CPT-4 and ICD-9-CM coding. When in doubt on a coding or billing matter, check with your individual payer.
If IUD insertion fails and payer balks, try the manufacturer
As for the supply, bill the payer for the IUD if an insertion attempt was made, because the attempt renders the supply unusable. In that case, it would be appropriate to add the modifier -52 to the supply code J7302. If the payer denies the claim for the supply, ask the manufacturer for a replacement or refund for the unusable IUD.
Discontinued service (modifier -53) can only be used when the procedure is discontinued due to a problem that threatened the well-being of the patient (such as increased or decreased blood pressure), and you must have carried out surgical prep and anesthesia induction.
Typically, IUD insertion fails because of cervical stenosis, and is coded 622.4 (stricture and stenosis of cervix)—unless another diagnosis explains the failed procedure.
Ms. Witt, former program manager in the Department of Coding and Nomenclature at the American College of Obstetricians and Gynecologists, is an independent coding and documentation consultant. Reimbursement Adviser reflects the most commonly accepted interpretations of CPT-4 and ICD-9-CM coding. When in doubt on a coding or billing matter, check with your individual payer.
As for the supply, bill the payer for the IUD if an insertion attempt was made, because the attempt renders the supply unusable. In that case, it would be appropriate to add the modifier -52 to the supply code J7302. If the payer denies the claim for the supply, ask the manufacturer for a replacement or refund for the unusable IUD.
Discontinued service (modifier -53) can only be used when the procedure is discontinued due to a problem that threatened the well-being of the patient (such as increased or decreased blood pressure), and you must have carried out surgical prep and anesthesia induction.
Typically, IUD insertion fails because of cervical stenosis, and is coded 622.4 (stricture and stenosis of cervix)—unless another diagnosis explains the failed procedure.
Ms. Witt, former program manager in the Department of Coding and Nomenclature at the American College of Obstetricians and Gynecologists, is an independent coding and documentation consultant. Reimbursement Adviser reflects the most commonly accepted interpretations of CPT-4 and ICD-9-CM coding. When in doubt on a coding or billing matter, check with your individual payer.
As for the supply, bill the payer for the IUD if an insertion attempt was made, because the attempt renders the supply unusable. In that case, it would be appropriate to add the modifier -52 to the supply code J7302. If the payer denies the claim for the supply, ask the manufacturer for a replacement or refund for the unusable IUD.
Discontinued service (modifier -53) can only be used when the procedure is discontinued due to a problem that threatened the well-being of the patient (such as increased or decreased blood pressure), and you must have carried out surgical prep and anesthesia induction.
Typically, IUD insertion fails because of cervical stenosis, and is coded 622.4 (stricture and stenosis of cervix)—unless another diagnosis explains the failed procedure.
Ms. Witt, former program manager in the Department of Coding and Nomenclature at the American College of Obstetricians and Gynecologists, is an independent coding and documentation consultant. Reimbursement Adviser reflects the most commonly accepted interpretations of CPT-4 and ICD-9-CM coding. When in doubt on a coding or billing matter, check with your individual payer.
Supracervical hysterectomy billing
But you need to add a modifier -52 (reduced services) because the surgeon elected not to remove the cervix.
Keep in mind that a new “S” code (S2078, laparoscopic supracervical hysterectomy [subtotal hysterectomy] with or without removal of tube[s], with or without removal of ovary[s]) is added to the national code set by Blue Cross/Blue Shield.
If you are billing a carrier that uses the “S” codes for processing claims, you must use the S code instead of code 58550/58553-52.
Ms. Witt, former program manager in the Department of Coding and Nomenclature at the American College of Obstetricians and Gynecologists, is an independent coding and documentation consultant. Reimbursement Adviser reflects the most commonly accepted interpretations of CPT-4 and ICD-9-CM coding. When in doubt on a coding or billing matter, check with your individual payer.
But you need to add a modifier -52 (reduced services) because the surgeon elected not to remove the cervix.
Keep in mind that a new “S” code (S2078, laparoscopic supracervical hysterectomy [subtotal hysterectomy] with or without removal of tube[s], with or without removal of ovary[s]) is added to the national code set by Blue Cross/Blue Shield.
If you are billing a carrier that uses the “S” codes for processing claims, you must use the S code instead of code 58550/58553-52.
Ms. Witt, former program manager in the Department of Coding and Nomenclature at the American College of Obstetricians and Gynecologists, is an independent coding and documentation consultant. Reimbursement Adviser reflects the most commonly accepted interpretations of CPT-4 and ICD-9-CM coding. When in doubt on a coding or billing matter, check with your individual payer.
But you need to add a modifier -52 (reduced services) because the surgeon elected not to remove the cervix.
Keep in mind that a new “S” code (S2078, laparoscopic supracervical hysterectomy [subtotal hysterectomy] with or without removal of tube[s], with or without removal of ovary[s]) is added to the national code set by Blue Cross/Blue Shield.
If you are billing a carrier that uses the “S” codes for processing claims, you must use the S code instead of code 58550/58553-52.
Ms. Witt, former program manager in the Department of Coding and Nomenclature at the American College of Obstetricians and Gynecologists, is an independent coding and documentation consultant. Reimbursement Adviser reflects the most commonly accepted interpretations of CPT-4 and ICD-9-CM coding. When in doubt on a coding or billing matter, check with your individual payer.
Use new code for digital occult blood screening
The revised CPT code 82270, however, affects the way you can bill for the guaiac fecal occult blood test.
The CPT 2006 revised code now states that the patient is provided with 3 cards or a single triple card for consecutive collection. The changed nomenclature states that this code is to be used for screening.
Effective January 1, 2006, the code 82270 does not apply when the physician takes the sample in the office.
The new code, 82272 (blood, occult, by peroxidase activity [guaiac], qualitative, feces, single specimen [from digital rectal exam]) should be used for this circumstance.
Ms. Witt, former program manager in the Department of Coding and Nomenclature at the American College of Obstetricians and Gynecologists, is an independent coding and documentation consultant. Reimbursement Adviser reflects the most commonly accepted interpretations of CPT-4 and ICD-9-CM coding. When in doubt on a coding or billing matter, check with your individual payer.
The revised CPT code 82270, however, affects the way you can bill for the guaiac fecal occult blood test.
The CPT 2006 revised code now states that the patient is provided with 3 cards or a single triple card for consecutive collection. The changed nomenclature states that this code is to be used for screening.
Effective January 1, 2006, the code 82270 does not apply when the physician takes the sample in the office.
The new code, 82272 (blood, occult, by peroxidase activity [guaiac], qualitative, feces, single specimen [from digital rectal exam]) should be used for this circumstance.
Ms. Witt, former program manager in the Department of Coding and Nomenclature at the American College of Obstetricians and Gynecologists, is an independent coding and documentation consultant. Reimbursement Adviser reflects the most commonly accepted interpretations of CPT-4 and ICD-9-CM coding. When in doubt on a coding or billing matter, check with your individual payer.
The revised CPT code 82270, however, affects the way you can bill for the guaiac fecal occult blood test.
The CPT 2006 revised code now states that the patient is provided with 3 cards or a single triple card for consecutive collection. The changed nomenclature states that this code is to be used for screening.
Effective January 1, 2006, the code 82270 does not apply when the physician takes the sample in the office.
The new code, 82272 (blood, occult, by peroxidase activity [guaiac], qualitative, feces, single specimen [from digital rectal exam]) should be used for this circumstance.
Ms. Witt, former program manager in the Department of Coding and Nomenclature at the American College of Obstetricians and Gynecologists, is an independent coding and documentation consultant. Reimbursement Adviser reflects the most commonly accepted interpretations of CPT-4 and ICD-9-CM coding. When in doubt on a coding or billing matter, check with your individual payer.
How to use new codes for 3D ultrasound
Two new codes represent 3D rendering of an ultrasound.
- Code 76376 is reported in addition to the basic service (detailed obstetric ultrasound 76811) when the image does not require image postprocessing on an independent workstation.
- Code 76377 is reported if image postprocessing is performed on an independent workstation.
According to CPT guidelines, these 2 codes also require “concurrent physician supervision of the image postprocessing 3D manipulation.” Previously, the only code available for 3D manipulation was 76375, a code that did not mention conversion from an ultrasound. Code 76375 has been deleted from CPT 2006.
Ms. Witt, former program manager in the Department of Coding and Nomenclature at the American College of Obstetricians and Gynecologists, is an independent coding and documentation consultant. Reimbursement Adviser reflects the most commonly accepted interpretations of CPT-4 and ICD-9-CM coding. When in doubt on a coding or billing matter, check with your individual payer.
Two new codes represent 3D rendering of an ultrasound.
- Code 76376 is reported in addition to the basic service (detailed obstetric ultrasound 76811) when the image does not require image postprocessing on an independent workstation.
- Code 76377 is reported if image postprocessing is performed on an independent workstation.
According to CPT guidelines, these 2 codes also require “concurrent physician supervision of the image postprocessing 3D manipulation.” Previously, the only code available for 3D manipulation was 76375, a code that did not mention conversion from an ultrasound. Code 76375 has been deleted from CPT 2006.
Ms. Witt, former program manager in the Department of Coding and Nomenclature at the American College of Obstetricians and Gynecologists, is an independent coding and documentation consultant. Reimbursement Adviser reflects the most commonly accepted interpretations of CPT-4 and ICD-9-CM coding. When in doubt on a coding or billing matter, check with your individual payer.
Two new codes represent 3D rendering of an ultrasound.
- Code 76376 is reported in addition to the basic service (detailed obstetric ultrasound 76811) when the image does not require image postprocessing on an independent workstation.
- Code 76377 is reported if image postprocessing is performed on an independent workstation.
According to CPT guidelines, these 2 codes also require “concurrent physician supervision of the image postprocessing 3D manipulation.” Previously, the only code available for 3D manipulation was 76375, a code that did not mention conversion from an ultrasound. Code 76375 has been deleted from CPT 2006.
Ms. Witt, former program manager in the Department of Coding and Nomenclature at the American College of Obstetricians and Gynecologists, is an independent coding and documentation consultant. Reimbursement Adviser reflects the most commonly accepted interpretations of CPT-4 and ICD-9-CM coding. When in doubt on a coding or billing matter, check with your individual payer.
Beware the Confidence Man
As I stepped from an exam room one busy morning last month, my office manager pulled me aside.
“Someone from the county courthouse is on the phone, and needs to talk to you right now,” she whispered.
“You know better than that,” I said. “While I'm seeing patients, I don't take calls from anyone except colleagues and immediate family.”
“He says he has a warrant for your arrest!”
I took the call.
“You failed to appear for jury duty,” the official-sounding voice said. That's a violation of New Jersey law, as you were warned when you received your jury summons. You'll have to come down here and surrender yourself immediately, or else we'll have to send deputies to your office. I don't think you'll want to be led through your waiting room in handcuffs.”
“Wait a minute,” I replied nervously. “I served on a jury less than a year ago. They said I wouldn't be called again for at least 3 years. There must be some mistake.”
“Perhaps we've confused you with a citizen with the same or a similar name,” he said. “Let me have your Social Security number and birth date.”
Alarm bells! Suddenly I realized what must be happening. “You should have that information already,” I replied. “Why don't you read me what you have?”
A short silence, and then … click.
I called the courthouse immediately. “Citizens who fail to appear receive a warning letter and a new questionnaire, not a phone call,” said the jury manager. “And we use driver license numbers to keep track of jurors.”
Like most other supposedly affluent professionals, doctors have always been popular targets for scam artists and con men, but their increasing creativity requires ever-higher levels of vigilance. This is especially true as the Internet becomes more popular and communication is facilitated. As the cartoon character Dilbert once said, there's a real dark side to the information age.
The phone company traced the call, which dead-ended at a Voice over Internet Protocol (VoIP) circuit, as the police warned me it probably would. I'll be discussing the many benefits of VoIP and its potential usefulness to your practice in a future column. But for now, know that the downside of VoIP is that unscrupulous individuals can use the technology to appear to be calling you from a legitimate business when they are not.
Those of us of a certain age remember phony calls offering great deals on office supplies or waiting room magazine subscriptions. As those capers became well known they gradually disappeared, but scam artists are endlessly creative in finding new, clever ways to target professionals.
The jury duty scheme, I learned, is an increasingly popular one. Others involve calls from the “fraud department” of your bank, claiming to be investigating a breach of your checking or savings account, or one of your credit or debit card accounts. Another purports to be a “customs official” informing you that you owe a big duty payment on an overseas shipment.
And then there are a few old standbys: the irresistible offer of a “preapproved,” unsecured loan; the good news that a distant relative you never met has died, leaving you lots of money; the packet of “confidential inside information” that will save you a bundle on taxes.
Usually, the common denominator, and the biggest red flag, is a request for a Social Security number, a birth date, a credit card number, or other private information that could be used to steal your identity or rob you blind.
You may think you would never be fooled for a minute by any of these schemes. But trust me: These guys are good. And they sound quite authentic, particularly when they surprise you in the midst of a busy schedule.
So stay alert, trust no one you don't know personally, and always be suspicious of unsolicited offers and unexpected “windfalls.” The cliché, “If it seems too good to be true, it probably is” is a cliché because it is true.
And always keep the following in mind:
▸ Do not give out bank account, Social Security, or credit card numbers over the telephone if you didn't initiate the call, no matter how legitimate the caller sounds. This is true of anyone claiming to be from a bank, a service company, or a government office, as well as anyone trying to sell you anything. If such callers insist upon “verifying” personal information, have them read the data to you from their records for you to confirm or deny.
▸ Court workers will never call to say you've missed jury duty, or that they are assembling jury pools and need to “prescreen” those who might be selected to serve on them. The police detectives I spoke with said they knew of no reason you would ever be called about jury service until after you had mailed back your completed questionnaire, and even then such a call would be extraordinary.
▸ Never send anyone a “commission” or “finder's fee” as a condition of receiving funds. In legitimate transactions, such fees are merely deducted from the money being paid out.
▸ Examine your credit card and bank account statements every month, keeping an eye out for unauthorized charges. Immediately challenge any items that you did not approve.
As I stepped from an exam room one busy morning last month, my office manager pulled me aside.
“Someone from the county courthouse is on the phone, and needs to talk to you right now,” she whispered.
“You know better than that,” I said. “While I'm seeing patients, I don't take calls from anyone except colleagues and immediate family.”
“He says he has a warrant for your arrest!”
I took the call.
“You failed to appear for jury duty,” the official-sounding voice said. That's a violation of New Jersey law, as you were warned when you received your jury summons. You'll have to come down here and surrender yourself immediately, or else we'll have to send deputies to your office. I don't think you'll want to be led through your waiting room in handcuffs.”
“Wait a minute,” I replied nervously. “I served on a jury less than a year ago. They said I wouldn't be called again for at least 3 years. There must be some mistake.”
“Perhaps we've confused you with a citizen with the same or a similar name,” he said. “Let me have your Social Security number and birth date.”
Alarm bells! Suddenly I realized what must be happening. “You should have that information already,” I replied. “Why don't you read me what you have?”
A short silence, and then … click.
I called the courthouse immediately. “Citizens who fail to appear receive a warning letter and a new questionnaire, not a phone call,” said the jury manager. “And we use driver license numbers to keep track of jurors.”
Like most other supposedly affluent professionals, doctors have always been popular targets for scam artists and con men, but their increasing creativity requires ever-higher levels of vigilance. This is especially true as the Internet becomes more popular and communication is facilitated. As the cartoon character Dilbert once said, there's a real dark side to the information age.
The phone company traced the call, which dead-ended at a Voice over Internet Protocol (VoIP) circuit, as the police warned me it probably would. I'll be discussing the many benefits of VoIP and its potential usefulness to your practice in a future column. But for now, know that the downside of VoIP is that unscrupulous individuals can use the technology to appear to be calling you from a legitimate business when they are not.
Those of us of a certain age remember phony calls offering great deals on office supplies or waiting room magazine subscriptions. As those capers became well known they gradually disappeared, but scam artists are endlessly creative in finding new, clever ways to target professionals.
The jury duty scheme, I learned, is an increasingly popular one. Others involve calls from the “fraud department” of your bank, claiming to be investigating a breach of your checking or savings account, or one of your credit or debit card accounts. Another purports to be a “customs official” informing you that you owe a big duty payment on an overseas shipment.
And then there are a few old standbys: the irresistible offer of a “preapproved,” unsecured loan; the good news that a distant relative you never met has died, leaving you lots of money; the packet of “confidential inside information” that will save you a bundle on taxes.
Usually, the common denominator, and the biggest red flag, is a request for a Social Security number, a birth date, a credit card number, or other private information that could be used to steal your identity or rob you blind.
You may think you would never be fooled for a minute by any of these schemes. But trust me: These guys are good. And they sound quite authentic, particularly when they surprise you in the midst of a busy schedule.
So stay alert, trust no one you don't know personally, and always be suspicious of unsolicited offers and unexpected “windfalls.” The cliché, “If it seems too good to be true, it probably is” is a cliché because it is true.
And always keep the following in mind:
▸ Do not give out bank account, Social Security, or credit card numbers over the telephone if you didn't initiate the call, no matter how legitimate the caller sounds. This is true of anyone claiming to be from a bank, a service company, or a government office, as well as anyone trying to sell you anything. If such callers insist upon “verifying” personal information, have them read the data to you from their records for you to confirm or deny.
▸ Court workers will never call to say you've missed jury duty, or that they are assembling jury pools and need to “prescreen” those who might be selected to serve on them. The police detectives I spoke with said they knew of no reason you would ever be called about jury service until after you had mailed back your completed questionnaire, and even then such a call would be extraordinary.
▸ Never send anyone a “commission” or “finder's fee” as a condition of receiving funds. In legitimate transactions, such fees are merely deducted from the money being paid out.
▸ Examine your credit card and bank account statements every month, keeping an eye out for unauthorized charges. Immediately challenge any items that you did not approve.
As I stepped from an exam room one busy morning last month, my office manager pulled me aside.
“Someone from the county courthouse is on the phone, and needs to talk to you right now,” she whispered.
“You know better than that,” I said. “While I'm seeing patients, I don't take calls from anyone except colleagues and immediate family.”
“He says he has a warrant for your arrest!”
I took the call.
“You failed to appear for jury duty,” the official-sounding voice said. That's a violation of New Jersey law, as you were warned when you received your jury summons. You'll have to come down here and surrender yourself immediately, or else we'll have to send deputies to your office. I don't think you'll want to be led through your waiting room in handcuffs.”
“Wait a minute,” I replied nervously. “I served on a jury less than a year ago. They said I wouldn't be called again for at least 3 years. There must be some mistake.”
“Perhaps we've confused you with a citizen with the same or a similar name,” he said. “Let me have your Social Security number and birth date.”
Alarm bells! Suddenly I realized what must be happening. “You should have that information already,” I replied. “Why don't you read me what you have?”
A short silence, and then … click.
I called the courthouse immediately. “Citizens who fail to appear receive a warning letter and a new questionnaire, not a phone call,” said the jury manager. “And we use driver license numbers to keep track of jurors.”
Like most other supposedly affluent professionals, doctors have always been popular targets for scam artists and con men, but their increasing creativity requires ever-higher levels of vigilance. This is especially true as the Internet becomes more popular and communication is facilitated. As the cartoon character Dilbert once said, there's a real dark side to the information age.
The phone company traced the call, which dead-ended at a Voice over Internet Protocol (VoIP) circuit, as the police warned me it probably would. I'll be discussing the many benefits of VoIP and its potential usefulness to your practice in a future column. But for now, know that the downside of VoIP is that unscrupulous individuals can use the technology to appear to be calling you from a legitimate business when they are not.
Those of us of a certain age remember phony calls offering great deals on office supplies or waiting room magazine subscriptions. As those capers became well known they gradually disappeared, but scam artists are endlessly creative in finding new, clever ways to target professionals.
The jury duty scheme, I learned, is an increasingly popular one. Others involve calls from the “fraud department” of your bank, claiming to be investigating a breach of your checking or savings account, or one of your credit or debit card accounts. Another purports to be a “customs official” informing you that you owe a big duty payment on an overseas shipment.
And then there are a few old standbys: the irresistible offer of a “preapproved,” unsecured loan; the good news that a distant relative you never met has died, leaving you lots of money; the packet of “confidential inside information” that will save you a bundle on taxes.
Usually, the common denominator, and the biggest red flag, is a request for a Social Security number, a birth date, a credit card number, or other private information that could be used to steal your identity or rob you blind.
You may think you would never be fooled for a minute by any of these schemes. But trust me: These guys are good. And they sound quite authentic, particularly when they surprise you in the midst of a busy schedule.
So stay alert, trust no one you don't know personally, and always be suspicious of unsolicited offers and unexpected “windfalls.” The cliché, “If it seems too good to be true, it probably is” is a cliché because it is true.
And always keep the following in mind:
▸ Do not give out bank account, Social Security, or credit card numbers over the telephone if you didn't initiate the call, no matter how legitimate the caller sounds. This is true of anyone claiming to be from a bank, a service company, or a government office, as well as anyone trying to sell you anything. If such callers insist upon “verifying” personal information, have them read the data to you from their records for you to confirm or deny.
▸ Court workers will never call to say you've missed jury duty, or that they are assembling jury pools and need to “prescreen” those who might be selected to serve on them. The police detectives I spoke with said they knew of no reason you would ever be called about jury service until after you had mailed back your completed questionnaire, and even then such a call would be extraordinary.
▸ Never send anyone a “commission” or “finder's fee” as a condition of receiving funds. In legitimate transactions, such fees are merely deducted from the money being paid out.
▸ Examine your credit card and bank account statements every month, keeping an eye out for unauthorized charges. Immediately challenge any items that you did not approve.
Medical Verdicts
Resident’s C-section injures multiple organs
A 28-year-old woman at term underwent a cesarean section for failure to progress after pushing for 2 hours.
A resident performing the cesarean lacerated the woman’s bladder, ureter, and vagina, ultimately necessitating a total hysterectomy.
In suing, the woman alleged the laceration of multiple organs was negligent. She claimed she had posttraumatic stress disorder, overactive bladder syndrome, dyspareunia, and chronic pelvic pain. She required placement of a nerve stimulator to calm the bladder and reduce her pain.
The defense conceded that surgical errors were made, but claimed the woman’s long-term medical conditions were not caused by the lacerations. Rather, the defense suggested, the hysterectomy and postsurgical complications were related to the pushing during the initial attempt at vaginal delivery.
- The jury awarded the plaintiff $17 million.
Patient claims she had the wrong operation
A woman with irregular menstrual cycles and chronic pelvic and abdominal pain in whom conservative treatment had failed was scheduled for a total abdominal hysterectomy. When her pain continued after the surgery, she consulted her surgeon, who had actually performed a right ovarian cystectomy and several other procedures instead of the total abdominal hysterectomy.
In suing, the woman claimed the surgeon failed to perform the agreed-upon procedure.
The surgeon maintained he did what was necessary and had discussed the potential for alternative scenarios with the woman prior to the surgery.
- The jury returned a defense verdict.
Marsupialization of cyst blamed for painful sex
A 46-year-old woman returned to her gynecologist for a recurrent Bartholin’s gland cyst after an initial incision and drainage. The woman believed she was undergoing a second incision and drainage.
The gynecologist’s colleague performed a partial marsupialization of the cyst to allow drainage and prevent a recurrence, allegedly without providing a consent form. After the procedure, the woman complained of pain during sexual intercourse that adversely affected her marital relationship.
In suing, the woman claimed the physician failed to obtain informed consent and failed to perform the procedure within the standard of care because the opening was allegedly larger than it should have been.
The physician claimed a discussion of the potential risks and complications took place before the procedure and, moreover, that a signed consent form is not a prerequisite to informed consent. The physician maintained the woman’s complaints of pain during sex were consistent with postmenopause. The defense also claimed the standard of care was met because the cyst did not recur afterward.
- The jury returned a defense verdict.
Residents blamed for fatal insulin overdose
A pregnant woman diagnosed with gestational diabetes was prescribed a daily dose of insulin at a family clinic by 2 residents and an attending physician. The woman received instructions on diet and insulin self-injection, on a Friday. According to the log of her blood sugar levels, she followed her medication regimen properly over the weekend, yet was found dead in her apartment on Monday. Autopsy revealed the cause of death was accidental insulin intoxication.
In suing the hospital, the estates for the mother and fetus alleged overprescription of insulin. The hospital denied either resident was acting as its agent. The defense claimed the residents were not negligent and had used the proper method for determining daily insulin dose and the proper means of insulin administration.
The defense also disputed the cause of death, asserting the blood tested for insulin level during the autopsy should have been obtained from a peripheral location (not an atrium of the heart) for an accurate reading of predeath level.
- The jury returned a defense verdict.
Did low incision cause paresthesias along legs?
A 54-year-old woman complaining of severe cramping and bleeding underwent a dilation and curettage, then a vaginal hysterectomy the next month. A year later the same surgeon removed the ovaries and performed a Marshall-Marchetti-Krantz procedure for incontinence. The woman began complaining of burning, pain, and tingling in the vaginal area and hips, then in her legs and ankles.
In suing, the woman claimed the incision for the MMK was too low and the MMK was the wrong procedure. She claimed that the MMK procedure entrapped the ilioinguinal and iliohypergastric nerves.
The physician maintained that the woman’s symptoms were unrelated to the surgery, and disagreed with the plaintiff’s assessment that the incision was “too low.”
- The jury awarded the plaintiff $709,000, which was reduced to $200,000 (the limit of the defendant’s insurance policy) because of the defendant’s bankruptcy.
Did mix-up on ultrasound lead to fetal death?
A day after a 36-year-old gravida at 36 weeks’ gestation was placed on bed rest for mild preeclampsia, she called the clinic to report that her fetus had stopped moving. The on-call family physician read the fetal heart monitor as nonreactive and ordered a STAT biophysical profile ultrasound and a follow-up ultrasound for later that night.
A complete obstetrical ultrasound was performed instead, and the records did not document any follow-up. A few days later at a regularly scheduled exam, fetal distress was diagnosed. Fetal monitoring at the hospital showed a fetal heart rate deceleration that led to an emergency c-section.
The infant did not have a detectable pulse until 16 minutes after birth. It was later determined that the mother had a fetal-maternal hemorrhage, leading to the loss of 75% of the infant’s blood. The child has cerebral palsy, cortical blindness, and spastic quadriplegia.
In suing, the woman claimed proper treatment would have avoided the brain damage. The defense claimed the brain damage occurred before her last clinic visit.
- The jury awarded the plaintiff $17 million, finding 80% liability with the hospital and 20% with the physicians.
Resident’s C-section injures multiple organs
A 28-year-old woman at term underwent a cesarean section for failure to progress after pushing for 2 hours.
A resident performing the cesarean lacerated the woman’s bladder, ureter, and vagina, ultimately necessitating a total hysterectomy.
In suing, the woman alleged the laceration of multiple organs was negligent. She claimed she had posttraumatic stress disorder, overactive bladder syndrome, dyspareunia, and chronic pelvic pain. She required placement of a nerve stimulator to calm the bladder and reduce her pain.
The defense conceded that surgical errors were made, but claimed the woman’s long-term medical conditions were not caused by the lacerations. Rather, the defense suggested, the hysterectomy and postsurgical complications were related to the pushing during the initial attempt at vaginal delivery.
- The jury awarded the plaintiff $17 million.
Patient claims she had the wrong operation
A woman with irregular menstrual cycles and chronic pelvic and abdominal pain in whom conservative treatment had failed was scheduled for a total abdominal hysterectomy. When her pain continued after the surgery, she consulted her surgeon, who had actually performed a right ovarian cystectomy and several other procedures instead of the total abdominal hysterectomy.
In suing, the woman claimed the surgeon failed to perform the agreed-upon procedure.
The surgeon maintained he did what was necessary and had discussed the potential for alternative scenarios with the woman prior to the surgery.
- The jury returned a defense verdict.
Marsupialization of cyst blamed for painful sex
A 46-year-old woman returned to her gynecologist for a recurrent Bartholin’s gland cyst after an initial incision and drainage. The woman believed she was undergoing a second incision and drainage.
The gynecologist’s colleague performed a partial marsupialization of the cyst to allow drainage and prevent a recurrence, allegedly without providing a consent form. After the procedure, the woman complained of pain during sexual intercourse that adversely affected her marital relationship.
In suing, the woman claimed the physician failed to obtain informed consent and failed to perform the procedure within the standard of care because the opening was allegedly larger than it should have been.
The physician claimed a discussion of the potential risks and complications took place before the procedure and, moreover, that a signed consent form is not a prerequisite to informed consent. The physician maintained the woman’s complaints of pain during sex were consistent with postmenopause. The defense also claimed the standard of care was met because the cyst did not recur afterward.
- The jury returned a defense verdict.
Residents blamed for fatal insulin overdose
A pregnant woman diagnosed with gestational diabetes was prescribed a daily dose of insulin at a family clinic by 2 residents and an attending physician. The woman received instructions on diet and insulin self-injection, on a Friday. According to the log of her blood sugar levels, she followed her medication regimen properly over the weekend, yet was found dead in her apartment on Monday. Autopsy revealed the cause of death was accidental insulin intoxication.
In suing the hospital, the estates for the mother and fetus alleged overprescription of insulin. The hospital denied either resident was acting as its agent. The defense claimed the residents were not negligent and had used the proper method for determining daily insulin dose and the proper means of insulin administration.
The defense also disputed the cause of death, asserting the blood tested for insulin level during the autopsy should have been obtained from a peripheral location (not an atrium of the heart) for an accurate reading of predeath level.
- The jury returned a defense verdict.
Did low incision cause paresthesias along legs?
A 54-year-old woman complaining of severe cramping and bleeding underwent a dilation and curettage, then a vaginal hysterectomy the next month. A year later the same surgeon removed the ovaries and performed a Marshall-Marchetti-Krantz procedure for incontinence. The woman began complaining of burning, pain, and tingling in the vaginal area and hips, then in her legs and ankles.
In suing, the woman claimed the incision for the MMK was too low and the MMK was the wrong procedure. She claimed that the MMK procedure entrapped the ilioinguinal and iliohypergastric nerves.
The physician maintained that the woman’s symptoms were unrelated to the surgery, and disagreed with the plaintiff’s assessment that the incision was “too low.”
- The jury awarded the plaintiff $709,000, which was reduced to $200,000 (the limit of the defendant’s insurance policy) because of the defendant’s bankruptcy.
Did mix-up on ultrasound lead to fetal death?
A day after a 36-year-old gravida at 36 weeks’ gestation was placed on bed rest for mild preeclampsia, she called the clinic to report that her fetus had stopped moving. The on-call family physician read the fetal heart monitor as nonreactive and ordered a STAT biophysical profile ultrasound and a follow-up ultrasound for later that night.
A complete obstetrical ultrasound was performed instead, and the records did not document any follow-up. A few days later at a regularly scheduled exam, fetal distress was diagnosed. Fetal monitoring at the hospital showed a fetal heart rate deceleration that led to an emergency c-section.
The infant did not have a detectable pulse until 16 minutes after birth. It was later determined that the mother had a fetal-maternal hemorrhage, leading to the loss of 75% of the infant’s blood. The child has cerebral palsy, cortical blindness, and spastic quadriplegia.
In suing, the woman claimed proper treatment would have avoided the brain damage. The defense claimed the brain damage occurred before her last clinic visit.
- The jury awarded the plaintiff $17 million, finding 80% liability with the hospital and 20% with the physicians.
Resident’s C-section injures multiple organs
A 28-year-old woman at term underwent a cesarean section for failure to progress after pushing for 2 hours.
A resident performing the cesarean lacerated the woman’s bladder, ureter, and vagina, ultimately necessitating a total hysterectomy.
In suing, the woman alleged the laceration of multiple organs was negligent. She claimed she had posttraumatic stress disorder, overactive bladder syndrome, dyspareunia, and chronic pelvic pain. She required placement of a nerve stimulator to calm the bladder and reduce her pain.
The defense conceded that surgical errors were made, but claimed the woman’s long-term medical conditions were not caused by the lacerations. Rather, the defense suggested, the hysterectomy and postsurgical complications were related to the pushing during the initial attempt at vaginal delivery.
- The jury awarded the plaintiff $17 million.
Patient claims she had the wrong operation
A woman with irregular menstrual cycles and chronic pelvic and abdominal pain in whom conservative treatment had failed was scheduled for a total abdominal hysterectomy. When her pain continued after the surgery, she consulted her surgeon, who had actually performed a right ovarian cystectomy and several other procedures instead of the total abdominal hysterectomy.
In suing, the woman claimed the surgeon failed to perform the agreed-upon procedure.
The surgeon maintained he did what was necessary and had discussed the potential for alternative scenarios with the woman prior to the surgery.
- The jury returned a defense verdict.
Marsupialization of cyst blamed for painful sex
A 46-year-old woman returned to her gynecologist for a recurrent Bartholin’s gland cyst after an initial incision and drainage. The woman believed she was undergoing a second incision and drainage.
The gynecologist’s colleague performed a partial marsupialization of the cyst to allow drainage and prevent a recurrence, allegedly without providing a consent form. After the procedure, the woman complained of pain during sexual intercourse that adversely affected her marital relationship.
In suing, the woman claimed the physician failed to obtain informed consent and failed to perform the procedure within the standard of care because the opening was allegedly larger than it should have been.
The physician claimed a discussion of the potential risks and complications took place before the procedure and, moreover, that a signed consent form is not a prerequisite to informed consent. The physician maintained the woman’s complaints of pain during sex were consistent with postmenopause. The defense also claimed the standard of care was met because the cyst did not recur afterward.
- The jury returned a defense verdict.
Residents blamed for fatal insulin overdose
A pregnant woman diagnosed with gestational diabetes was prescribed a daily dose of insulin at a family clinic by 2 residents and an attending physician. The woman received instructions on diet and insulin self-injection, on a Friday. According to the log of her blood sugar levels, she followed her medication regimen properly over the weekend, yet was found dead in her apartment on Monday. Autopsy revealed the cause of death was accidental insulin intoxication.
In suing the hospital, the estates for the mother and fetus alleged overprescription of insulin. The hospital denied either resident was acting as its agent. The defense claimed the residents were not negligent and had used the proper method for determining daily insulin dose and the proper means of insulin administration.
The defense also disputed the cause of death, asserting the blood tested for insulin level during the autopsy should have been obtained from a peripheral location (not an atrium of the heart) for an accurate reading of predeath level.
- The jury returned a defense verdict.
Did low incision cause paresthesias along legs?
A 54-year-old woman complaining of severe cramping and bleeding underwent a dilation and curettage, then a vaginal hysterectomy the next month. A year later the same surgeon removed the ovaries and performed a Marshall-Marchetti-Krantz procedure for incontinence. The woman began complaining of burning, pain, and tingling in the vaginal area and hips, then in her legs and ankles.
In suing, the woman claimed the incision for the MMK was too low and the MMK was the wrong procedure. She claimed that the MMK procedure entrapped the ilioinguinal and iliohypergastric nerves.
The physician maintained that the woman’s symptoms were unrelated to the surgery, and disagreed with the plaintiff’s assessment that the incision was “too low.”
- The jury awarded the plaintiff $709,000, which was reduced to $200,000 (the limit of the defendant’s insurance policy) because of the defendant’s bankruptcy.
Did mix-up on ultrasound lead to fetal death?
A day after a 36-year-old gravida at 36 weeks’ gestation was placed on bed rest for mild preeclampsia, she called the clinic to report that her fetus had stopped moving. The on-call family physician read the fetal heart monitor as nonreactive and ordered a STAT biophysical profile ultrasound and a follow-up ultrasound for later that night.
A complete obstetrical ultrasound was performed instead, and the records did not document any follow-up. A few days later at a regularly scheduled exam, fetal distress was diagnosed. Fetal monitoring at the hospital showed a fetal heart rate deceleration that led to an emergency c-section.
The infant did not have a detectable pulse until 16 minutes after birth. It was later determined that the mother had a fetal-maternal hemorrhage, leading to the loss of 75% of the infant’s blood. The child has cerebral palsy, cortical blindness, and spastic quadriplegia.
In suing, the woman claimed proper treatment would have avoided the brain damage. The defense claimed the brain damage occurred before her last clinic visit.
- The jury awarded the plaintiff $17 million, finding 80% liability with the hospital and 20% with the physicians.
Slashing Accounts Receivable, Part II
I knew my December 2005 column, which suggested asking each patient for a credit card number and billing balances to the card account as they come in, was an idea whose time had come. But I was quite unprepared for the huge volume of feedback—more, by far, than any column before it. (If you missed that column, you'll find it at the Web site, www.skinandallergynews.com
Questions and requests for copies of my letter of explanation and consent form continue to pour in, even now. Many of the questions are similar, so I've decided to answer the more common ones this month.
Don't your patients object to signing, in effect, a blank check?
Some did object initially—mostly older people. Nowadays a wide chasm seems to have formed in financial philosophies, right at about age 35. If you're older than that, for example, when you receive your checking account statement each month you probably say, “Thank goodness they still include copies of my canceled checks.” If you're younger, you probably say, “Why do they send all this paper with each statement?”
But when we explain that we're doing nothing different than most restaurants and online businesses, and it will work to patients' advantage by decreasing the bills they will receive and the checks they must write, most come around.
And they're not “signing a blank check”—all credit card contracts give cardholders the right to challenge any charge against their account, and we remind them of that.
Once you've collected the credit card information, where do you store it, and how do you keep it secure?
We keep it in the patient's chart, where it is guarded with the same level of security as the rest of that patient's privileged information.
Some offices prefer to store it all in one place—a Rolodex-type container, or an Excel (or Quickbooks, or similar) computer file, for example—protected by locked cabinets, passwords, and any other precautions that might be necessary.
Couldn't this be considered “balance billing” and therefore illegal?
This is not “balance billing,” which is asking patients to pay the difference between your normal fee and the insurer's normal payment. If you have a contract with the insurer, that's illegal—or more precisely, it's a breach of your contract. What you charge to the patient's credit card is the portion of the insurer-determined payment not paid by the insurer. For example, you bill $200, the payer approves $100 and pays 80% of that. The remaining $20 is the patient's responsibility, and that is what you charge to the credit card, rather than sending the patient a statement for that amount.
We instituted this policy after you suggested it in your American Academy of Dermatology course. So far one patient has called to ask if it is legal, and one insurance company has inquired about it. How do you respond to such queries?
Of course it's legal. (See above.) Ask those patients if they question the legality every time they check into a hotel or rent a car. We have had no inquiries from insurers, but my response would be it's none of their business.
You have every right to collect the patient-owed portion of your fees, and insurance companies have no say in how you do it.
How do you handle patients who refuse to hand over a number, particularly those who claim they have no credit cards?
We used to let refusers slide, but as of Jan. 1, we've made the policy mandatory. Patients who refuse without a good reason are asked, like any patient who refuses to cooperate with any standard office policy, to go elsewhere. Life's too short. And “I don't have any credit cards” does not count as a good reason. Everybody has credit cards in this day and age, except deadbeats with such awful credit that you don't want them anyway. My office manager does have authority to make exceptions on a case-by-case basis, however.
One surgeon I know asks “no credit card” patients to pay a lawyer-style “retainer” of $500 which is held in escrow and used to pay receivable amounts as they come due. When presented with that alternative, most suddenly remember that they do have a credit card after all.
Do you envision using this policy to enforce any no-show charges a practice might have?
I had not, but now I am. Excellent suggestion!
I knew my December 2005 column, which suggested asking each patient for a credit card number and billing balances to the card account as they come in, was an idea whose time had come. But I was quite unprepared for the huge volume of feedback—more, by far, than any column before it. (If you missed that column, you'll find it at the Web site, www.skinandallergynews.com
Questions and requests for copies of my letter of explanation and consent form continue to pour in, even now. Many of the questions are similar, so I've decided to answer the more common ones this month.
Don't your patients object to signing, in effect, a blank check?
Some did object initially—mostly older people. Nowadays a wide chasm seems to have formed in financial philosophies, right at about age 35. If you're older than that, for example, when you receive your checking account statement each month you probably say, “Thank goodness they still include copies of my canceled checks.” If you're younger, you probably say, “Why do they send all this paper with each statement?”
But when we explain that we're doing nothing different than most restaurants and online businesses, and it will work to patients' advantage by decreasing the bills they will receive and the checks they must write, most come around.
And they're not “signing a blank check”—all credit card contracts give cardholders the right to challenge any charge against their account, and we remind them of that.
Once you've collected the credit card information, where do you store it, and how do you keep it secure?
We keep it in the patient's chart, where it is guarded with the same level of security as the rest of that patient's privileged information.
Some offices prefer to store it all in one place—a Rolodex-type container, or an Excel (or Quickbooks, or similar) computer file, for example—protected by locked cabinets, passwords, and any other precautions that might be necessary.
Couldn't this be considered “balance billing” and therefore illegal?
This is not “balance billing,” which is asking patients to pay the difference between your normal fee and the insurer's normal payment. If you have a contract with the insurer, that's illegal—or more precisely, it's a breach of your contract. What you charge to the patient's credit card is the portion of the insurer-determined payment not paid by the insurer. For example, you bill $200, the payer approves $100 and pays 80% of that. The remaining $20 is the patient's responsibility, and that is what you charge to the credit card, rather than sending the patient a statement for that amount.
We instituted this policy after you suggested it in your American Academy of Dermatology course. So far one patient has called to ask if it is legal, and one insurance company has inquired about it. How do you respond to such queries?
Of course it's legal. (See above.) Ask those patients if they question the legality every time they check into a hotel or rent a car. We have had no inquiries from insurers, but my response would be it's none of their business.
You have every right to collect the patient-owed portion of your fees, and insurance companies have no say in how you do it.
How do you handle patients who refuse to hand over a number, particularly those who claim they have no credit cards?
We used to let refusers slide, but as of Jan. 1, we've made the policy mandatory. Patients who refuse without a good reason are asked, like any patient who refuses to cooperate with any standard office policy, to go elsewhere. Life's too short. And “I don't have any credit cards” does not count as a good reason. Everybody has credit cards in this day and age, except deadbeats with such awful credit that you don't want them anyway. My office manager does have authority to make exceptions on a case-by-case basis, however.
One surgeon I know asks “no credit card” patients to pay a lawyer-style “retainer” of $500 which is held in escrow and used to pay receivable amounts as they come due. When presented with that alternative, most suddenly remember that they do have a credit card after all.
Do you envision using this policy to enforce any no-show charges a practice might have?
I had not, but now I am. Excellent suggestion!
I knew my December 2005 column, which suggested asking each patient for a credit card number and billing balances to the card account as they come in, was an idea whose time had come. But I was quite unprepared for the huge volume of feedback—more, by far, than any column before it. (If you missed that column, you'll find it at the Web site, www.skinandallergynews.com
Questions and requests for copies of my letter of explanation and consent form continue to pour in, even now. Many of the questions are similar, so I've decided to answer the more common ones this month.
Don't your patients object to signing, in effect, a blank check?
Some did object initially—mostly older people. Nowadays a wide chasm seems to have formed in financial philosophies, right at about age 35. If you're older than that, for example, when you receive your checking account statement each month you probably say, “Thank goodness they still include copies of my canceled checks.” If you're younger, you probably say, “Why do they send all this paper with each statement?”
But when we explain that we're doing nothing different than most restaurants and online businesses, and it will work to patients' advantage by decreasing the bills they will receive and the checks they must write, most come around.
And they're not “signing a blank check”—all credit card contracts give cardholders the right to challenge any charge against their account, and we remind them of that.
Once you've collected the credit card information, where do you store it, and how do you keep it secure?
We keep it in the patient's chart, where it is guarded with the same level of security as the rest of that patient's privileged information.
Some offices prefer to store it all in one place—a Rolodex-type container, or an Excel (or Quickbooks, or similar) computer file, for example—protected by locked cabinets, passwords, and any other precautions that might be necessary.
Couldn't this be considered “balance billing” and therefore illegal?
This is not “balance billing,” which is asking patients to pay the difference between your normal fee and the insurer's normal payment. If you have a contract with the insurer, that's illegal—or more precisely, it's a breach of your contract. What you charge to the patient's credit card is the portion of the insurer-determined payment not paid by the insurer. For example, you bill $200, the payer approves $100 and pays 80% of that. The remaining $20 is the patient's responsibility, and that is what you charge to the credit card, rather than sending the patient a statement for that amount.
We instituted this policy after you suggested it in your American Academy of Dermatology course. So far one patient has called to ask if it is legal, and one insurance company has inquired about it. How do you respond to such queries?
Of course it's legal. (See above.) Ask those patients if they question the legality every time they check into a hotel or rent a car. We have had no inquiries from insurers, but my response would be it's none of their business.
You have every right to collect the patient-owed portion of your fees, and insurance companies have no say in how you do it.
How do you handle patients who refuse to hand over a number, particularly those who claim they have no credit cards?
We used to let refusers slide, but as of Jan. 1, we've made the policy mandatory. Patients who refuse without a good reason are asked, like any patient who refuses to cooperate with any standard office policy, to go elsewhere. Life's too short. And “I don't have any credit cards” does not count as a good reason. Everybody has credit cards in this day and age, except deadbeats with such awful credit that you don't want them anyway. My office manager does have authority to make exceptions on a case-by-case basis, however.
One surgeon I know asks “no credit card” patients to pay a lawyer-style “retainer” of $500 which is held in escrow and used to pay receivable amounts as they come due. When presented with that alternative, most suddenly remember that they do have a credit card after all.
Do you envision using this policy to enforce any no-show charges a practice might have?
I had not, but now I am. Excellent suggestion!
Lax protocols blamed for delayed birth
A woman admitted for delivery was under the care of her family physician, who ruptured her membranes. Within 1 to 2 minutes the fetal heart tracing showed a prolonged deceleration from 150 to 60 bpm lasting 4.5 minutes. A vaginal exam revealed a loop of cord along the left side of the infant’s head. During the next 28 minutes, the fetal heart rate ranged from 60 to 120 bpm with evidence of significant fetal distress, including several instances in which the heart rate was lost altogether.
The physician lifted the infant’s head, reducing the cord, and instructed the mother to push. The infant was born with a fractured right humerus, a small subdural bleed, and an intracerebral contusion.
The child now has limited cognition, residing in a nursing home for 24-hour care. He has a gastric tube and a tracheostomy.
In suing, the family claimed the infant sustained severe brain damage from anoxia. They claimed the physician was negligent in failing to order a cesarean section. They claimed the hospital lacked a written on-call protocol and call list, resulting in the primary OB being busy in another hospital and the back-up OB being more than 45 minutes away.
The physician asserted he was unaware of a prolapsed cord at the time and that the records were written in retrospect. The hospital maintained its on-call policy was correct. The defendants claimed the infant’s injuries were related to something other than anoxia from the prolapsed cord.
- The case settled for $11 million.
A woman admitted for delivery was under the care of her family physician, who ruptured her membranes. Within 1 to 2 minutes the fetal heart tracing showed a prolonged deceleration from 150 to 60 bpm lasting 4.5 minutes. A vaginal exam revealed a loop of cord along the left side of the infant’s head. During the next 28 minutes, the fetal heart rate ranged from 60 to 120 bpm with evidence of significant fetal distress, including several instances in which the heart rate was lost altogether.
The physician lifted the infant’s head, reducing the cord, and instructed the mother to push. The infant was born with a fractured right humerus, a small subdural bleed, and an intracerebral contusion.
The child now has limited cognition, residing in a nursing home for 24-hour care. He has a gastric tube and a tracheostomy.
In suing, the family claimed the infant sustained severe brain damage from anoxia. They claimed the physician was negligent in failing to order a cesarean section. They claimed the hospital lacked a written on-call protocol and call list, resulting in the primary OB being busy in another hospital and the back-up OB being more than 45 minutes away.
The physician asserted he was unaware of a prolapsed cord at the time and that the records were written in retrospect. The hospital maintained its on-call policy was correct. The defendants claimed the infant’s injuries were related to something other than anoxia from the prolapsed cord.
- The case settled for $11 million.
A woman admitted for delivery was under the care of her family physician, who ruptured her membranes. Within 1 to 2 minutes the fetal heart tracing showed a prolonged deceleration from 150 to 60 bpm lasting 4.5 minutes. A vaginal exam revealed a loop of cord along the left side of the infant’s head. During the next 28 minutes, the fetal heart rate ranged from 60 to 120 bpm with evidence of significant fetal distress, including several instances in which the heart rate was lost altogether.
The physician lifted the infant’s head, reducing the cord, and instructed the mother to push. The infant was born with a fractured right humerus, a small subdural bleed, and an intracerebral contusion.
The child now has limited cognition, residing in a nursing home for 24-hour care. He has a gastric tube and a tracheostomy.
In suing, the family claimed the infant sustained severe brain damage from anoxia. They claimed the physician was negligent in failing to order a cesarean section. They claimed the hospital lacked a written on-call protocol and call list, resulting in the primary OB being busy in another hospital and the back-up OB being more than 45 minutes away.
The physician asserted he was unaware of a prolapsed cord at the time and that the records were written in retrospect. The hospital maintained its on-call policy was correct. The defendants claimed the infant’s injuries were related to something other than anoxia from the prolapsed cord.
- The case settled for $11 million.