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Wrong ovary removed during hysterectomy
A 31-year-old woman had a diseased right ovary that caused severe dysplasia, dysmenorrhea, dyspareunia, and right side pelvic pain. She underwent a total abdominal hysterectomy with right salpingo-oophorectomy. In his postoperative report the physician admitted to removing the wrong ovary; an ultrasound revealed that the diseased ovary remained. Another physician surgically removed the ovary, which contained a benign hemorrhagic cyst and prominent fibrous adhesions.
- A confidential settlement was reached.
A 31-year-old woman had a diseased right ovary that caused severe dysplasia, dysmenorrhea, dyspareunia, and right side pelvic pain. She underwent a total abdominal hysterectomy with right salpingo-oophorectomy. In his postoperative report the physician admitted to removing the wrong ovary; an ultrasound revealed that the diseased ovary remained. Another physician surgically removed the ovary, which contained a benign hemorrhagic cyst and prominent fibrous adhesions.
- A confidential settlement was reached.
A 31-year-old woman had a diseased right ovary that caused severe dysplasia, dysmenorrhea, dyspareunia, and right side pelvic pain. She underwent a total abdominal hysterectomy with right salpingo-oophorectomy. In his postoperative report the physician admitted to removing the wrong ovary; an ultrasound revealed that the diseased ovary remained. Another physician surgically removed the ovary, which contained a benign hemorrhagic cyst and prominent fibrous adhesions.
- A confidential settlement was reached.
C-section complicated by burns and bleeding
While a woman was undergoing a cesarean section, the surgical drape caught on fire as the surgeon used a Bovie cautery unit. To control bleeding the surgeon removed the right fallopian tube and ovary.
In suing, the woman asserted she had burn injuries due to the fire and that removal of the fallopian tube and ovary was unnecessary.
The defense alleged that the surgeon had no role in causing the fire and that removal of the fallopian tube and ovary was necessary to control bleeding and ensure hemostasis.
- The hospital settled for an undisclosed amount prior to the jury returning a verdict in favor of the physician.
While a woman was undergoing a cesarean section, the surgical drape caught on fire as the surgeon used a Bovie cautery unit. To control bleeding the surgeon removed the right fallopian tube and ovary.
In suing, the woman asserted she had burn injuries due to the fire and that removal of the fallopian tube and ovary was unnecessary.
The defense alleged that the surgeon had no role in causing the fire and that removal of the fallopian tube and ovary was necessary to control bleeding and ensure hemostasis.
- The hospital settled for an undisclosed amount prior to the jury returning a verdict in favor of the physician.
While a woman was undergoing a cesarean section, the surgical drape caught on fire as the surgeon used a Bovie cautery unit. To control bleeding the surgeon removed the right fallopian tube and ovary.
In suing, the woman asserted she had burn injuries due to the fire and that removal of the fallopian tube and ovary was unnecessary.
The defense alleged that the surgeon had no role in causing the fire and that removal of the fallopian tube and ovary was necessary to control bleeding and ensure hemostasis.
- The hospital settled for an undisclosed amount prior to the jury returning a verdict in favor of the physician.
Did injuries necessitate cesarean sections?
After a miscarriage at 13 weeks’ gestation, a woman in her late 30s underwent a dilatation and curettage (D&C) by her obstetrician. After 6 months of complications she underwent surgery that included removal of a diseased section of her sigmoid colon and a colostomy. After the colostomy was closed, she underwent a myomectomy and removal of uterine fibroids. Subsequently, the woman gave birth to 3 healthy male infants by cesarean section.
In suing, the woman claimed the obstetrician was negligent in perforating the uterus and bowel during the D&C, which necessitated the colostomy and cesarean deliveries.
The obstetrician argued that the injuries were a known risk of D&C and said the uterine injury did not necessitate the cesarean deliveries, but that the fibroid removal did.
- The jury returned a defense verdict.
After a miscarriage at 13 weeks’ gestation, a woman in her late 30s underwent a dilatation and curettage (D&C) by her obstetrician. After 6 months of complications she underwent surgery that included removal of a diseased section of her sigmoid colon and a colostomy. After the colostomy was closed, she underwent a myomectomy and removal of uterine fibroids. Subsequently, the woman gave birth to 3 healthy male infants by cesarean section.
In suing, the woman claimed the obstetrician was negligent in perforating the uterus and bowel during the D&C, which necessitated the colostomy and cesarean deliveries.
The obstetrician argued that the injuries were a known risk of D&C and said the uterine injury did not necessitate the cesarean deliveries, but that the fibroid removal did.
- The jury returned a defense verdict.
After a miscarriage at 13 weeks’ gestation, a woman in her late 30s underwent a dilatation and curettage (D&C) by her obstetrician. After 6 months of complications she underwent surgery that included removal of a diseased section of her sigmoid colon and a colostomy. After the colostomy was closed, she underwent a myomectomy and removal of uterine fibroids. Subsequently, the woman gave birth to 3 healthy male infants by cesarean section.
In suing, the woman claimed the obstetrician was negligent in perforating the uterus and bowel during the D&C, which necessitated the colostomy and cesarean deliveries.
The obstetrician argued that the injuries were a known risk of D&C and said the uterine injury did not necessitate the cesarean deliveries, but that the fibroid removal did.
- The jury returned a defense verdict.
Nuchal cord problem blamed for stillbirth
<court>Middlesex County (Mass) Superior Court</court>
A 30-year-old woman presented to the hospital in labor at full term. Labor was uneventful until 3:10 AM, when fetal heart tones allegedly suggested distress. The pattern continued, and moderate meconium was noted at 5:20 AM. At 6:00 AM, increased meconium was noted. The heart rate dropped to 80 bpm at 6:24 AM and to 60 bpm 5 minutes later.
An attempt was made to deliver the child by vacuum extraction; ultimately the infant was stillborn. Autopsy revealed normal anatomy and development with nuchal cord entanglement.
In suing, the woman claimed the defendant ignored signs of fetal distress and failed to initiate a cesarean section in a timely manner.
The defense contended that the decision to proceed vaginally was appropriate because the mother was nearly ready to deliver. The defense also claimed there was no sentinel hypoxic event before or during labor, and that the cord most likely tightened at the very end of labor.
- The parties reached a settlement of $525,000.
The cases in this column are selected by the editors of OBG Management from Medical Malpractice Verdicts, Settlements & Experts, with permission of the editor, Lewis Laska, of Nashville, Tenn (www.verdictslaska.com). While there are instances when the available information is incomplete, these cases represent the types of clinical situations that typically result in litigation.
<court>Middlesex County (Mass) Superior Court</court>
A 30-year-old woman presented to the hospital in labor at full term. Labor was uneventful until 3:10 AM, when fetal heart tones allegedly suggested distress. The pattern continued, and moderate meconium was noted at 5:20 AM. At 6:00 AM, increased meconium was noted. The heart rate dropped to 80 bpm at 6:24 AM and to 60 bpm 5 minutes later.
An attempt was made to deliver the child by vacuum extraction; ultimately the infant was stillborn. Autopsy revealed normal anatomy and development with nuchal cord entanglement.
In suing, the woman claimed the defendant ignored signs of fetal distress and failed to initiate a cesarean section in a timely manner.
The defense contended that the decision to proceed vaginally was appropriate because the mother was nearly ready to deliver. The defense also claimed there was no sentinel hypoxic event before or during labor, and that the cord most likely tightened at the very end of labor.
- The parties reached a settlement of $525,000.
The cases in this column are selected by the editors of OBG Management from Medical Malpractice Verdicts, Settlements & Experts, with permission of the editor, Lewis Laska, of Nashville, Tenn (www.verdictslaska.com). While there are instances when the available information is incomplete, these cases represent the types of clinical situations that typically result in litigation.
<court>Middlesex County (Mass) Superior Court</court>
A 30-year-old woman presented to the hospital in labor at full term. Labor was uneventful until 3:10 AM, when fetal heart tones allegedly suggested distress. The pattern continued, and moderate meconium was noted at 5:20 AM. At 6:00 AM, increased meconium was noted. The heart rate dropped to 80 bpm at 6:24 AM and to 60 bpm 5 minutes later.
An attempt was made to deliver the child by vacuum extraction; ultimately the infant was stillborn. Autopsy revealed normal anatomy and development with nuchal cord entanglement.
In suing, the woman claimed the defendant ignored signs of fetal distress and failed to initiate a cesarean section in a timely manner.
The defense contended that the decision to proceed vaginally was appropriate because the mother was nearly ready to deliver. The defense also claimed there was no sentinel hypoxic event before or during labor, and that the cord most likely tightened at the very end of labor.
- The parties reached a settlement of $525,000.
The cases in this column are selected by the editors of OBG Management from Medical Malpractice Verdicts, Settlements & Experts, with permission of the editor, Lewis Laska, of Nashville, Tenn (www.verdictslaska.com). While there are instances when the available information is incomplete, these cases represent the types of clinical situations that typically result in litigation.
Using new ICD-9 codes for everyday dilemmas
CODING DILEMMA
How do you prevent a “missed period” visit from being incorrectly assigned to the global obstetric package?
Sandra has missed her period and suspects she may be pregnant. You examine her and perform a urine pregnancy test, which confirms the gestation. After giving her a prescription for vitamins and a lab slip for prenatal testing, you ask her to make an appointment in 2 weeks to begin prenatal care.
Now we have a new code (V72.42, pregnancy examination or test) to report the first encounter with the patient at which pregnancy is confirmed. Before the latest batch of new codes, which took effect October 1, the American College of Obstetricians and Gynecologists (ACOG) recommended using ICD-9-CM code 626.8 (missed period) for this office visit, though the “missed period” code implied disease rather than pregnancy. ICD-9-CM rules mandate coding for what is known at the end of a visit. Previously, codes V22.0 or V22.1 (supervision of normal pregnancy) were the only choices.
This pregnancy is not yet being supervised. The visit to confirm pregnancy now will generally be a low-level evaluation and management (E/M) service and is billed outside the global obstetric package because the patient’s pregnancy is not yet being supervised. The new code V72.42 makes this clear.
Changes for the better
That’s just one of the welcome diagnostic code additions in the International Classification of Diseases–9th Edition–Clinical Modification, thanks to the efforts of ACOG.
Besides the new code for pregnancy confirmation, there are codes for:
- multiple pregnancy that has been reduced in number
- expanded genetic counseling and testing
- oocyte donor, blood typing, and other pregnancy-related codes abnormal Papanicolaou smear has simpler wording.
- 2 codes designate cancer therapy: chemotherapy or immunotherapy
- family history of osteoporosis
- personal history of urinary tract infections
- tracking overweight and obese patients
CERVICAL SCREENING
CODING DILEMMA
What is the best way to code low-risk HPV?
Greta, 42, undergoes cervical sampling by the Papanicolaou test and human papillomavirus (HPV) test; the latter is positive for low-risk HPV types.
Code 795.09, other abnormal Papanicolaou smear of cervix and cervical HPV, has been revised slightly. The example of when to assign this code now reads “cervical low-risk human papillomavirus (HPV) DNA test positive.”
Simpler wording. This revision has simplified the wording of the example, clarifying its use, and does not change how the code is reported.
PHYSICAL EXAM PRIOR TO PROCEDURE
CODING DILEMMA
How do you distinguish preop exams from specialized exams of a specific area or system?
Rachel, 42, is scheduled to undergo uterine artery embolization for fibroids, and you perform the preoperative examination.
V72.83, other specified preoperative examination, and V72.84, preoperative examination, unspecified, have been revised to clarify that they should be reported when a general physical examination was performed prior to surgery or a procedure.
History of specific problems
Several codes have been added to allow ObGyns to use more specific history information relating to the patient’s condition or concerns:
- V13.02, personal history of urinary (tract) infection
- V15.88, personal history of fall or risk for falling
- V17.81, family history of osteoporosis
- V18.9, family history of genetic disease carrier.
OBESITY
CODING DILEMMA
What code indicates overweight necessitating intervention?
Alisha is 32 and weighs 180 lb, a heavy load for her 5 ft 2 inch frame. She reports that her health insurance will cover her membership costs for any 1 of several weight loss programs, provided she can demonstrate that she is significantly overweight.
The concerns of the medical community about the increasing prevalence of overweight and obesity (and, more rarely, underweight) and the link to many disease conditions has prompted ICD-9-CM to add several new codes for reporting a woman’s weight.
Supports insurance claims? Code 278.02, overweight, was added and linked to the new codes that report the patient’s body mass index (BMI). The national standards classify a patient as underweight, normal, overweight, obese, or morbidly obese based on the documented BMI; this information may assist patients in receiving treatment for their obesity through insurance coverage.
To calculate BMI, multiply weight in pounds by 703/height in inches squared. The ideal BMI is 20 to 25. Underweight patients have a BMI of 19 or less.
Before the new code for overweight can be entered in Alisha’s case, her BMI would need to be documented at 25 or above. Since her BMI is 32.9, she would fall into the obese category, which includes BMIs of 30 to 34.9. Someone who is morbidly obese has a BMI of 40 or more, or a BMI of more than 35 with 1 or more comorbid conditions such as hypertension, heart disease, high cholesterol, diabetes, severe joint pain, or arthritis.
The new BMI codes (V85.0–V85.4) are reported for any adult older than 20. Next year, codes will be added for patients who are between 2 and 20 years of age.
MULTIPLE GESTATION
CODING DILEMMA
Should a pregnancy be coded differently after a fetal reduction procedure?
Mariana, 40, undergoes in vitro fertilization with implantation of 2 embryos, but later, because of her age and health (she has metabolic syndrome), requests fetal reduction for a singleton gestation.
Multifetal pregnancy reduction is billed using CPT code 59866, and we now have a new ICD-9-CM code to characterize such gestations after the procedure: 651.7X, multiple gestation following (elective) fetal reduction.
The last digit can be 0, episode of care unspecified; 1, delivered with or without mention of antepartum condition; or 3, antepartum condition or complication.
High risk remains. Though fetal reduction will generally reduce risk to the remaining fetuses, the pregnancy is still considered high-risk. ICD-9-CM staff have clarified that this code should be reported even if, as in Mariana’s case, the pregnancy is reduced to a singleton gestation, as fetal reduction is a complicating factor.
ABNORMAL GLUCOSE TOLERANCE
CODING DILEMMA
Is there a specific code for elevated glucose tolerance test?
At 28 weeks’ gestation, Rebecca reports symptoms suggesting hyperglycemia, so you order blood glucose testing, which reveals elevated glucose tolerance.
Code 648.8X, abnormal glucose tolerance, has been revised to include conditions classifiable as 790.21 through 790.29, and a note was added to report V58.67 for associated long-term (current) insulin use.
Codes 790.21 through 790.29 are used to report specific abnormal glucose findings and may be added as a secondary diagnosis to clarify the abnormal result in pregnancy. For instance, code 790.21 is reported if the patient has elevated fasting glucose, while 790.22 indicates she has an elevated glucose tolerance test, as in Rebecca’s case.
Other pregancy-related codes
Obstructed labor. In other pregnancy-related changes, ICD-9-CM has clarified use of 660.8X, other causes of obstructed labor, to require an additional code to identify the cause. For instance, if the internal orifice is total obstructed by a tumor, use code 660.8X as the primary diagnosis and 653.8X, disproportion of other origin.
Procreative management. V59.7, donor, egg (oocyte) (ovum) has been added, and includes five 5-digit codes for type of donor. Using them properly requires knowing the age and status (eg, anonymous or not) of the donor. If no information about the donor’s age is available, the unspecified code V59.70 is used. Otherwise the choices are V59.71 and V59.73 for anonymous donors under age 35 and 35 and over, respectively, and V59.72 and V59.74 for donors under age 35 and 35 and over, respectively, whose eggs are to go to a designated recipient.
Blood typing. V72.86, encounter for blood typing, now can be used to report testing of the father when the mother is Rh-negative. This information allows physicians to determine the risk of Rh sensitization in the fetus and decide whether immunoglobulin administration is necessary to prevent it during the remainder of the pregnancy.
CODING DILEMMA
How do you prevent a “missed period” visit from being incorrectly assigned to the global obstetric package?
Sandra has missed her period and suspects she may be pregnant. You examine her and perform a urine pregnancy test, which confirms the gestation. After giving her a prescription for vitamins and a lab slip for prenatal testing, you ask her to make an appointment in 2 weeks to begin prenatal care.
Now we have a new code (V72.42, pregnancy examination or test) to report the first encounter with the patient at which pregnancy is confirmed. Before the latest batch of new codes, which took effect October 1, the American College of Obstetricians and Gynecologists (ACOG) recommended using ICD-9-CM code 626.8 (missed period) for this office visit, though the “missed period” code implied disease rather than pregnancy. ICD-9-CM rules mandate coding for what is known at the end of a visit. Previously, codes V22.0 or V22.1 (supervision of normal pregnancy) were the only choices.
This pregnancy is not yet being supervised. The visit to confirm pregnancy now will generally be a low-level evaluation and management (E/M) service and is billed outside the global obstetric package because the patient’s pregnancy is not yet being supervised. The new code V72.42 makes this clear.
Changes for the better
That’s just one of the welcome diagnostic code additions in the International Classification of Diseases–9th Edition–Clinical Modification, thanks to the efforts of ACOG.
Besides the new code for pregnancy confirmation, there are codes for:
- multiple pregnancy that has been reduced in number
- expanded genetic counseling and testing
- oocyte donor, blood typing, and other pregnancy-related codes abnormal Papanicolaou smear has simpler wording.
- 2 codes designate cancer therapy: chemotherapy or immunotherapy
- family history of osteoporosis
- personal history of urinary tract infections
- tracking overweight and obese patients
CERVICAL SCREENING
CODING DILEMMA
What is the best way to code low-risk HPV?
Greta, 42, undergoes cervical sampling by the Papanicolaou test and human papillomavirus (HPV) test; the latter is positive for low-risk HPV types.
Code 795.09, other abnormal Papanicolaou smear of cervix and cervical HPV, has been revised slightly. The example of when to assign this code now reads “cervical low-risk human papillomavirus (HPV) DNA test positive.”
Simpler wording. This revision has simplified the wording of the example, clarifying its use, and does not change how the code is reported.
PHYSICAL EXAM PRIOR TO PROCEDURE
CODING DILEMMA
How do you distinguish preop exams from specialized exams of a specific area or system?
Rachel, 42, is scheduled to undergo uterine artery embolization for fibroids, and you perform the preoperative examination.
V72.83, other specified preoperative examination, and V72.84, preoperative examination, unspecified, have been revised to clarify that they should be reported when a general physical examination was performed prior to surgery or a procedure.
History of specific problems
Several codes have been added to allow ObGyns to use more specific history information relating to the patient’s condition or concerns:
- V13.02, personal history of urinary (tract) infection
- V15.88, personal history of fall or risk for falling
- V17.81, family history of osteoporosis
- V18.9, family history of genetic disease carrier.
OBESITY
CODING DILEMMA
What code indicates overweight necessitating intervention?
Alisha is 32 and weighs 180 lb, a heavy load for her 5 ft 2 inch frame. She reports that her health insurance will cover her membership costs for any 1 of several weight loss programs, provided she can demonstrate that she is significantly overweight.
The concerns of the medical community about the increasing prevalence of overweight and obesity (and, more rarely, underweight) and the link to many disease conditions has prompted ICD-9-CM to add several new codes for reporting a woman’s weight.
Supports insurance claims? Code 278.02, overweight, was added and linked to the new codes that report the patient’s body mass index (BMI). The national standards classify a patient as underweight, normal, overweight, obese, or morbidly obese based on the documented BMI; this information may assist patients in receiving treatment for their obesity through insurance coverage.
To calculate BMI, multiply weight in pounds by 703/height in inches squared. The ideal BMI is 20 to 25. Underweight patients have a BMI of 19 or less.
Before the new code for overweight can be entered in Alisha’s case, her BMI would need to be documented at 25 or above. Since her BMI is 32.9, she would fall into the obese category, which includes BMIs of 30 to 34.9. Someone who is morbidly obese has a BMI of 40 or more, or a BMI of more than 35 with 1 or more comorbid conditions such as hypertension, heart disease, high cholesterol, diabetes, severe joint pain, or arthritis.
The new BMI codes (V85.0–V85.4) are reported for any adult older than 20. Next year, codes will be added for patients who are between 2 and 20 years of age.
MULTIPLE GESTATION
CODING DILEMMA
Should a pregnancy be coded differently after a fetal reduction procedure?
Mariana, 40, undergoes in vitro fertilization with implantation of 2 embryos, but later, because of her age and health (she has metabolic syndrome), requests fetal reduction for a singleton gestation.
Multifetal pregnancy reduction is billed using CPT code 59866, and we now have a new ICD-9-CM code to characterize such gestations after the procedure: 651.7X, multiple gestation following (elective) fetal reduction.
The last digit can be 0, episode of care unspecified; 1, delivered with or without mention of antepartum condition; or 3, antepartum condition or complication.
High risk remains. Though fetal reduction will generally reduce risk to the remaining fetuses, the pregnancy is still considered high-risk. ICD-9-CM staff have clarified that this code should be reported even if, as in Mariana’s case, the pregnancy is reduced to a singleton gestation, as fetal reduction is a complicating factor.
ABNORMAL GLUCOSE TOLERANCE
CODING DILEMMA
Is there a specific code for elevated glucose tolerance test?
At 28 weeks’ gestation, Rebecca reports symptoms suggesting hyperglycemia, so you order blood glucose testing, which reveals elevated glucose tolerance.
Code 648.8X, abnormal glucose tolerance, has been revised to include conditions classifiable as 790.21 through 790.29, and a note was added to report V58.67 for associated long-term (current) insulin use.
Codes 790.21 through 790.29 are used to report specific abnormal glucose findings and may be added as a secondary diagnosis to clarify the abnormal result in pregnancy. For instance, code 790.21 is reported if the patient has elevated fasting glucose, while 790.22 indicates she has an elevated glucose tolerance test, as in Rebecca’s case.
Other pregancy-related codes
Obstructed labor. In other pregnancy-related changes, ICD-9-CM has clarified use of 660.8X, other causes of obstructed labor, to require an additional code to identify the cause. For instance, if the internal orifice is total obstructed by a tumor, use code 660.8X as the primary diagnosis and 653.8X, disproportion of other origin.
Procreative management. V59.7, donor, egg (oocyte) (ovum) has been added, and includes five 5-digit codes for type of donor. Using them properly requires knowing the age and status (eg, anonymous or not) of the donor. If no information about the donor’s age is available, the unspecified code V59.70 is used. Otherwise the choices are V59.71 and V59.73 for anonymous donors under age 35 and 35 and over, respectively, and V59.72 and V59.74 for donors under age 35 and 35 and over, respectively, whose eggs are to go to a designated recipient.
Blood typing. V72.86, encounter for blood typing, now can be used to report testing of the father when the mother is Rh-negative. This information allows physicians to determine the risk of Rh sensitization in the fetus and decide whether immunoglobulin administration is necessary to prevent it during the remainder of the pregnancy.
CODING DILEMMA
How do you prevent a “missed period” visit from being incorrectly assigned to the global obstetric package?
Sandra has missed her period and suspects she may be pregnant. You examine her and perform a urine pregnancy test, which confirms the gestation. After giving her a prescription for vitamins and a lab slip for prenatal testing, you ask her to make an appointment in 2 weeks to begin prenatal care.
Now we have a new code (V72.42, pregnancy examination or test) to report the first encounter with the patient at which pregnancy is confirmed. Before the latest batch of new codes, which took effect October 1, the American College of Obstetricians and Gynecologists (ACOG) recommended using ICD-9-CM code 626.8 (missed period) for this office visit, though the “missed period” code implied disease rather than pregnancy. ICD-9-CM rules mandate coding for what is known at the end of a visit. Previously, codes V22.0 or V22.1 (supervision of normal pregnancy) were the only choices.
This pregnancy is not yet being supervised. The visit to confirm pregnancy now will generally be a low-level evaluation and management (E/M) service and is billed outside the global obstetric package because the patient’s pregnancy is not yet being supervised. The new code V72.42 makes this clear.
Changes for the better
That’s just one of the welcome diagnostic code additions in the International Classification of Diseases–9th Edition–Clinical Modification, thanks to the efforts of ACOG.
Besides the new code for pregnancy confirmation, there are codes for:
- multiple pregnancy that has been reduced in number
- expanded genetic counseling and testing
- oocyte donor, blood typing, and other pregnancy-related codes abnormal Papanicolaou smear has simpler wording.
- 2 codes designate cancer therapy: chemotherapy or immunotherapy
- family history of osteoporosis
- personal history of urinary tract infections
- tracking overweight and obese patients
CERVICAL SCREENING
CODING DILEMMA
What is the best way to code low-risk HPV?
Greta, 42, undergoes cervical sampling by the Papanicolaou test and human papillomavirus (HPV) test; the latter is positive for low-risk HPV types.
Code 795.09, other abnormal Papanicolaou smear of cervix and cervical HPV, has been revised slightly. The example of when to assign this code now reads “cervical low-risk human papillomavirus (HPV) DNA test positive.”
Simpler wording. This revision has simplified the wording of the example, clarifying its use, and does not change how the code is reported.
PHYSICAL EXAM PRIOR TO PROCEDURE
CODING DILEMMA
How do you distinguish preop exams from specialized exams of a specific area or system?
Rachel, 42, is scheduled to undergo uterine artery embolization for fibroids, and you perform the preoperative examination.
V72.83, other specified preoperative examination, and V72.84, preoperative examination, unspecified, have been revised to clarify that they should be reported when a general physical examination was performed prior to surgery or a procedure.
History of specific problems
Several codes have been added to allow ObGyns to use more specific history information relating to the patient’s condition or concerns:
- V13.02, personal history of urinary (tract) infection
- V15.88, personal history of fall or risk for falling
- V17.81, family history of osteoporosis
- V18.9, family history of genetic disease carrier.
OBESITY
CODING DILEMMA
What code indicates overweight necessitating intervention?
Alisha is 32 and weighs 180 lb, a heavy load for her 5 ft 2 inch frame. She reports that her health insurance will cover her membership costs for any 1 of several weight loss programs, provided she can demonstrate that she is significantly overweight.
The concerns of the medical community about the increasing prevalence of overweight and obesity (and, more rarely, underweight) and the link to many disease conditions has prompted ICD-9-CM to add several new codes for reporting a woman’s weight.
Supports insurance claims? Code 278.02, overweight, was added and linked to the new codes that report the patient’s body mass index (BMI). The national standards classify a patient as underweight, normal, overweight, obese, or morbidly obese based on the documented BMI; this information may assist patients in receiving treatment for their obesity through insurance coverage.
To calculate BMI, multiply weight in pounds by 703/height in inches squared. The ideal BMI is 20 to 25. Underweight patients have a BMI of 19 or less.
Before the new code for overweight can be entered in Alisha’s case, her BMI would need to be documented at 25 or above. Since her BMI is 32.9, she would fall into the obese category, which includes BMIs of 30 to 34.9. Someone who is morbidly obese has a BMI of 40 or more, or a BMI of more than 35 with 1 or more comorbid conditions such as hypertension, heart disease, high cholesterol, diabetes, severe joint pain, or arthritis.
The new BMI codes (V85.0–V85.4) are reported for any adult older than 20. Next year, codes will be added for patients who are between 2 and 20 years of age.
MULTIPLE GESTATION
CODING DILEMMA
Should a pregnancy be coded differently after a fetal reduction procedure?
Mariana, 40, undergoes in vitro fertilization with implantation of 2 embryos, but later, because of her age and health (she has metabolic syndrome), requests fetal reduction for a singleton gestation.
Multifetal pregnancy reduction is billed using CPT code 59866, and we now have a new ICD-9-CM code to characterize such gestations after the procedure: 651.7X, multiple gestation following (elective) fetal reduction.
The last digit can be 0, episode of care unspecified; 1, delivered with or without mention of antepartum condition; or 3, antepartum condition or complication.
High risk remains. Though fetal reduction will generally reduce risk to the remaining fetuses, the pregnancy is still considered high-risk. ICD-9-CM staff have clarified that this code should be reported even if, as in Mariana’s case, the pregnancy is reduced to a singleton gestation, as fetal reduction is a complicating factor.
ABNORMAL GLUCOSE TOLERANCE
CODING DILEMMA
Is there a specific code for elevated glucose tolerance test?
At 28 weeks’ gestation, Rebecca reports symptoms suggesting hyperglycemia, so you order blood glucose testing, which reveals elevated glucose tolerance.
Code 648.8X, abnormal glucose tolerance, has been revised to include conditions classifiable as 790.21 through 790.29, and a note was added to report V58.67 for associated long-term (current) insulin use.
Codes 790.21 through 790.29 are used to report specific abnormal glucose findings and may be added as a secondary diagnosis to clarify the abnormal result in pregnancy. For instance, code 790.21 is reported if the patient has elevated fasting glucose, while 790.22 indicates she has an elevated glucose tolerance test, as in Rebecca’s case.
Other pregancy-related codes
Obstructed labor. In other pregnancy-related changes, ICD-9-CM has clarified use of 660.8X, other causes of obstructed labor, to require an additional code to identify the cause. For instance, if the internal orifice is total obstructed by a tumor, use code 660.8X as the primary diagnosis and 653.8X, disproportion of other origin.
Procreative management. V59.7, donor, egg (oocyte) (ovum) has been added, and includes five 5-digit codes for type of donor. Using them properly requires knowing the age and status (eg, anonymous or not) of the donor. If no information about the donor’s age is available, the unspecified code V59.70 is used. Otherwise the choices are V59.71 and V59.73 for anonymous donors under age 35 and 35 and over, respectively, and V59.72 and V59.74 for donors under age 35 and 35 and over, respectively, whose eggs are to go to a designated recipient.
Blood typing. V72.86, encounter for blood typing, now can be used to report testing of the father when the mother is Rh-negative. This information allows physicians to determine the risk of Rh sensitization in the fetus and decide whether immunoglobulin administration is necessary to prevent it during the remainder of the pregnancy.
Searching the Web, Part 2
My recent column on Web searching techniques has generated more questions, comments, and discussion than any other. (If you missed that column, you can find it on the SKIN & ALLERGY NEWS Web site, www.skinandallergynews.com
Obviously this is a popular topic. As well it should be, because as I mentioned in that column, the sheer volume of information on the Web makes quick and efficient searching an indispensable skill.
But once you have become quick and efficient at finding the information you need, a new problem arises: The information changes! All the good medical, news, and other information-based Web sites change and update their content on a regular but unpredictable basis. And checking each one for new information can be very tedious, if you can remember to do it at all.
Many sites offer an e-mail service to notify you of new content, but multiple e-mail subscriptions clutter your inbox and often can't select out the information you're really interested in. RSS feeds are a more efficient and increasingly popular method of staying current on all the subjects, medical and otherwise, which interest you.
RSS (which stands for “Rich Site Summary” or “Really Simple Syndication,” depending on whom you ask) is a file format, and Web sites use that format (or a similar one called “Atom”) to produce a summary file, or “feed,” of new content, along with links to full versions of that content. When you subscribe to a given Web site's feed, you'll receive a summary of new content each time the Web site is updated.
Thousands of Web sites now offer RSS feeds, including most of the large medical information services, all the major news organizations, and many Web logs.
To subscribe to feeds you must download a program called a “feed reader,” which is basically just a browser specializing in RSS and Atom files. Dozens of readers (also known as “aggregators”) are available, and more are coming as RSS grows in popularity. Some can be accessed through browsers, others are integrated into e-mail programs, and still others run as standalone applications.
Many readers are free, but you'll pay a nominal fee for those with the most advanced features. (As always, I have no financial interest in any of the enterprises discussed in this column.) A comprehensive list of available readers, free and otherwise, can be found at http://en.wikipedia.org/wiki/List_of_news_aggregators
It's not always easy to find out whether a particular Web site offers a feed, because there is no universally recognized method of indicating its existence. Look for a link to “RSS” or “Syndicate This,” or an orange rectangle with the letters “XML” (don't ask) or “RSS”. These links aren't always on the home page. Sometimes, on the site map, you'll find a link to a Web page explaining available feeds and how to find them.
Some of the major sites have multiple feeds to choose from. For example, you can generate a feed of current stories related to the page that you're looking at on Google News by clicking the RSS ∣ Atom links on any Google News page.
Once you know the Web address (URL) of the RSS feed you want, you provide it to your reader program, which will monitor the feed for you. (Many RSS aggregators come preconfigured with a list of feed URLs for popular news Web sites.)
In addition to notifying you of important news headlines, changes to your favorite Web sites, and new developments in any medical (or other) field of interest to you, RSS feeds have many other uses. Some of the more popular ones are notification of arrival of new products in a store or catalog, announcing new newsletter issues (including e-mail newsletters), weather and other changing-condition alerts, and notification of additions of new items to a database, or new members to a group.
And you can expect to see many more new uses of RSS feeds in the near future.
It can work the other way, too: If you want readers of your Web site to receive the latest news about your practice, such as new treatments and procedures you're offering, you can create your own RSS feed. Any competent Web administrator will know how to do it, or you can do it yourself if you're so inclined.
Some will insist on doing it from scratch, but for the rest of us, a multitude of tools is available to simplify the process. (If your site includes a blog, for example, many blogging tools automatically create RSS files.)
Detailed instructions abound. You can find them easily with—what else?—your favorite search engine!
My recent column on Web searching techniques has generated more questions, comments, and discussion than any other. (If you missed that column, you can find it on the SKIN & ALLERGY NEWS Web site, www.skinandallergynews.com
Obviously this is a popular topic. As well it should be, because as I mentioned in that column, the sheer volume of information on the Web makes quick and efficient searching an indispensable skill.
But once you have become quick and efficient at finding the information you need, a new problem arises: The information changes! All the good medical, news, and other information-based Web sites change and update their content on a regular but unpredictable basis. And checking each one for new information can be very tedious, if you can remember to do it at all.
Many sites offer an e-mail service to notify you of new content, but multiple e-mail subscriptions clutter your inbox and often can't select out the information you're really interested in. RSS feeds are a more efficient and increasingly popular method of staying current on all the subjects, medical and otherwise, which interest you.
RSS (which stands for “Rich Site Summary” or “Really Simple Syndication,” depending on whom you ask) is a file format, and Web sites use that format (or a similar one called “Atom”) to produce a summary file, or “feed,” of new content, along with links to full versions of that content. When you subscribe to a given Web site's feed, you'll receive a summary of new content each time the Web site is updated.
Thousands of Web sites now offer RSS feeds, including most of the large medical information services, all the major news organizations, and many Web logs.
To subscribe to feeds you must download a program called a “feed reader,” which is basically just a browser specializing in RSS and Atom files. Dozens of readers (also known as “aggregators”) are available, and more are coming as RSS grows in popularity. Some can be accessed through browsers, others are integrated into e-mail programs, and still others run as standalone applications.
Many readers are free, but you'll pay a nominal fee for those with the most advanced features. (As always, I have no financial interest in any of the enterprises discussed in this column.) A comprehensive list of available readers, free and otherwise, can be found at http://en.wikipedia.org/wiki/List_of_news_aggregators
It's not always easy to find out whether a particular Web site offers a feed, because there is no universally recognized method of indicating its existence. Look for a link to “RSS” or “Syndicate This,” or an orange rectangle with the letters “XML” (don't ask) or “RSS”. These links aren't always on the home page. Sometimes, on the site map, you'll find a link to a Web page explaining available feeds and how to find them.
Some of the major sites have multiple feeds to choose from. For example, you can generate a feed of current stories related to the page that you're looking at on Google News by clicking the RSS ∣ Atom links on any Google News page.
Once you know the Web address (URL) of the RSS feed you want, you provide it to your reader program, which will monitor the feed for you. (Many RSS aggregators come preconfigured with a list of feed URLs for popular news Web sites.)
In addition to notifying you of important news headlines, changes to your favorite Web sites, and new developments in any medical (or other) field of interest to you, RSS feeds have many other uses. Some of the more popular ones are notification of arrival of new products in a store or catalog, announcing new newsletter issues (including e-mail newsletters), weather and other changing-condition alerts, and notification of additions of new items to a database, or new members to a group.
And you can expect to see many more new uses of RSS feeds in the near future.
It can work the other way, too: If you want readers of your Web site to receive the latest news about your practice, such as new treatments and procedures you're offering, you can create your own RSS feed. Any competent Web administrator will know how to do it, or you can do it yourself if you're so inclined.
Some will insist on doing it from scratch, but for the rest of us, a multitude of tools is available to simplify the process. (If your site includes a blog, for example, many blogging tools automatically create RSS files.)
Detailed instructions abound. You can find them easily with—what else?—your favorite search engine!
My recent column on Web searching techniques has generated more questions, comments, and discussion than any other. (If you missed that column, you can find it on the SKIN & ALLERGY NEWS Web site, www.skinandallergynews.com
Obviously this is a popular topic. As well it should be, because as I mentioned in that column, the sheer volume of information on the Web makes quick and efficient searching an indispensable skill.
But once you have become quick and efficient at finding the information you need, a new problem arises: The information changes! All the good medical, news, and other information-based Web sites change and update their content on a regular but unpredictable basis. And checking each one for new information can be very tedious, if you can remember to do it at all.
Many sites offer an e-mail service to notify you of new content, but multiple e-mail subscriptions clutter your inbox and often can't select out the information you're really interested in. RSS feeds are a more efficient and increasingly popular method of staying current on all the subjects, medical and otherwise, which interest you.
RSS (which stands for “Rich Site Summary” or “Really Simple Syndication,” depending on whom you ask) is a file format, and Web sites use that format (or a similar one called “Atom”) to produce a summary file, or “feed,” of new content, along with links to full versions of that content. When you subscribe to a given Web site's feed, you'll receive a summary of new content each time the Web site is updated.
Thousands of Web sites now offer RSS feeds, including most of the large medical information services, all the major news organizations, and many Web logs.
To subscribe to feeds you must download a program called a “feed reader,” which is basically just a browser specializing in RSS and Atom files. Dozens of readers (also known as “aggregators”) are available, and more are coming as RSS grows in popularity. Some can be accessed through browsers, others are integrated into e-mail programs, and still others run as standalone applications.
Many readers are free, but you'll pay a nominal fee for those with the most advanced features. (As always, I have no financial interest in any of the enterprises discussed in this column.) A comprehensive list of available readers, free and otherwise, can be found at http://en.wikipedia.org/wiki/List_of_news_aggregators
It's not always easy to find out whether a particular Web site offers a feed, because there is no universally recognized method of indicating its existence. Look for a link to “RSS” or “Syndicate This,” or an orange rectangle with the letters “XML” (don't ask) or “RSS”. These links aren't always on the home page. Sometimes, on the site map, you'll find a link to a Web page explaining available feeds and how to find them.
Some of the major sites have multiple feeds to choose from. For example, you can generate a feed of current stories related to the page that you're looking at on Google News by clicking the RSS ∣ Atom links on any Google News page.
Once you know the Web address (URL) of the RSS feed you want, you provide it to your reader program, which will monitor the feed for you. (Many RSS aggregators come preconfigured with a list of feed URLs for popular news Web sites.)
In addition to notifying you of important news headlines, changes to your favorite Web sites, and new developments in any medical (or other) field of interest to you, RSS feeds have many other uses. Some of the more popular ones are notification of arrival of new products in a store or catalog, announcing new newsletter issues (including e-mail newsletters), weather and other changing-condition alerts, and notification of additions of new items to a database, or new members to a group.
And you can expect to see many more new uses of RSS feeds in the near future.
It can work the other way, too: If you want readers of your Web site to receive the latest news about your practice, such as new treatments and procedures you're offering, you can create your own RSS feed. Any competent Web administrator will know how to do it, or you can do it yourself if you're so inclined.
Some will insist on doing it from scratch, but for the rest of us, a multitude of tools is available to simplify the process. (If your site includes a blog, for example, many blogging tools automatically create RSS files.)
Detailed instructions abound. You can find them easily with—what else?—your favorite search engine!
Bladder cut in endometriosis repair
A 32-year-old woman underwent laparoscopic surgery for endometriosis. During the procedure the surgeon noticed a bulge in the lower right ligament. Believing it to be a fibrous mass or tumor, he excised a portion of tissue for examination.
It was then discovered that the bulge was actually caused by a Foley catheter bulb pressing against the broad ligament, and that the incision to remove the bulge had cut into the bladder. A urologist performed a minilaparotomy and cystoscopy to repair the damage. The patient required prolonged hospitalization and recovery time and had permanent scarring.
In suing, the patient faulted the defendant for failing to locate the catheter or consider that it might have caused the bulge. The defendant claimed there was no reason to suspect that the catheter bulb might be in that location.
- The jury returned a defense verdict.
A 32-year-old woman underwent laparoscopic surgery for endometriosis. During the procedure the surgeon noticed a bulge in the lower right ligament. Believing it to be a fibrous mass or tumor, he excised a portion of tissue for examination.
It was then discovered that the bulge was actually caused by a Foley catheter bulb pressing against the broad ligament, and that the incision to remove the bulge had cut into the bladder. A urologist performed a minilaparotomy and cystoscopy to repair the damage. The patient required prolonged hospitalization and recovery time and had permanent scarring.
In suing, the patient faulted the defendant for failing to locate the catheter or consider that it might have caused the bulge. The defendant claimed there was no reason to suspect that the catheter bulb might be in that location.
- The jury returned a defense verdict.
A 32-year-old woman underwent laparoscopic surgery for endometriosis. During the procedure the surgeon noticed a bulge in the lower right ligament. Believing it to be a fibrous mass or tumor, he excised a portion of tissue for examination.
It was then discovered that the bulge was actually caused by a Foley catheter bulb pressing against the broad ligament, and that the incision to remove the bulge had cut into the bladder. A urologist performed a minilaparotomy and cystoscopy to repair the damage. The patient required prolonged hospitalization and recovery time and had permanent scarring.
In suing, the patient faulted the defendant for failing to locate the catheter or consider that it might have caused the bulge. The defendant claimed there was no reason to suspect that the catheter bulb might be in that location.
- The jury returned a defense verdict.
Was lack of cesarean cause of brain damage?
A 17-year-old girl went to the hospital to give birth. For several hours a fetal heart monitor showed decelerations, which later dropped sharply. The obstetrician and nurse-midwife failed to initiate a cesarean section, leading to fetal oxygen deprivation during delivery and brain damage. The child will never be able to walk, talk, or live on his own.
During the defense the obstetrician claimed she was not informed of the difficulties during labor, but the nurse-midwife contended that she had alerted the obstetrician to the need for a cesarean section.
- The obstetrician settled for $1 million.
- The jury awarded the plaintiff $9.6 million, appointing 80% fault to the obstetrician and 20% fault to the nurse-midwife.
A 17-year-old girl went to the hospital to give birth. For several hours a fetal heart monitor showed decelerations, which later dropped sharply. The obstetrician and nurse-midwife failed to initiate a cesarean section, leading to fetal oxygen deprivation during delivery and brain damage. The child will never be able to walk, talk, or live on his own.
During the defense the obstetrician claimed she was not informed of the difficulties during labor, but the nurse-midwife contended that she had alerted the obstetrician to the need for a cesarean section.
- The obstetrician settled for $1 million.
- The jury awarded the plaintiff $9.6 million, appointing 80% fault to the obstetrician and 20% fault to the nurse-midwife.
A 17-year-old girl went to the hospital to give birth. For several hours a fetal heart monitor showed decelerations, which later dropped sharply. The obstetrician and nurse-midwife failed to initiate a cesarean section, leading to fetal oxygen deprivation during delivery and brain damage. The child will never be able to walk, talk, or live on his own.
During the defense the obstetrician claimed she was not informed of the difficulties during labor, but the nurse-midwife contended that she had alerted the obstetrician to the need for a cesarean section.
- The obstetrician settled for $1 million.
- The jury awarded the plaintiff $9.6 million, appointing 80% fault to the obstetrician and 20% fault to the nurse-midwife.
Woman dies after laparotomy
<court>Cook County (Ill) District Court</court>
A 66-year-old woman underwent an open laparotomy for removal of a uterine fibroid after an unsuccessful laparoscopic procedure. Postoperative infection, acute respiratory distress syndrome (ARDS), bowel perforation, and abscess developed. Despite surgical exploration and repair 2 weeks after the initial surgery, the woman died a month after the repair.
In suing, the family claimed that the defendants failed to diagnose and treat the perforated bowel in a timely manner and failed to order a STAT CT scan and surgical consult. The defense contended that a STAT CT scan and surgical consult were not indicated on admission to the ICU 3 days after the original surgery and that the CT done 3 days later with aspiration and drainage was appropriate for the ARDS diagnosis.
- The jury returned a defense verdict.
The cases in this column are selected by the editors of OBG Management from Medical Malpractice Verdicts, Settlements & Experts, with permission of the editor, Lewis Laska, of Nashville, Tenn (www.verdictslaska.com). While there are instances when the available information is incomplete, these cases represent the types of clinical situations that typically result in litigation.
<court>Cook County (Ill) District Court</court>
A 66-year-old woman underwent an open laparotomy for removal of a uterine fibroid after an unsuccessful laparoscopic procedure. Postoperative infection, acute respiratory distress syndrome (ARDS), bowel perforation, and abscess developed. Despite surgical exploration and repair 2 weeks after the initial surgery, the woman died a month after the repair.
In suing, the family claimed that the defendants failed to diagnose and treat the perforated bowel in a timely manner and failed to order a STAT CT scan and surgical consult. The defense contended that a STAT CT scan and surgical consult were not indicated on admission to the ICU 3 days after the original surgery and that the CT done 3 days later with aspiration and drainage was appropriate for the ARDS diagnosis.
- The jury returned a defense verdict.
The cases in this column are selected by the editors of OBG Management from Medical Malpractice Verdicts, Settlements & Experts, with permission of the editor, Lewis Laska, of Nashville, Tenn (www.verdictslaska.com). While there are instances when the available information is incomplete, these cases represent the types of clinical situations that typically result in litigation.
<court>Cook County (Ill) District Court</court>
A 66-year-old woman underwent an open laparotomy for removal of a uterine fibroid after an unsuccessful laparoscopic procedure. Postoperative infection, acute respiratory distress syndrome (ARDS), bowel perforation, and abscess developed. Despite surgical exploration and repair 2 weeks after the initial surgery, the woman died a month after the repair.
In suing, the family claimed that the defendants failed to diagnose and treat the perforated bowel in a timely manner and failed to order a STAT CT scan and surgical consult. The defense contended that a STAT CT scan and surgical consult were not indicated on admission to the ICU 3 days after the original surgery and that the CT done 3 days later with aspiration and drainage was appropriate for the ARDS diagnosis.
- The jury returned a defense verdict.
The cases in this column are selected by the editors of OBG Management from Medical Malpractice Verdicts, Settlements & Experts, with permission of the editor, Lewis Laska, of Nashville, Tenn (www.verdictslaska.com). While there are instances when the available information is incomplete, these cases represent the types of clinical situations that typically result in litigation.
What factors caused low IQ?
A mother who had already delivered 5 infants weighing less than 8 lb each became pregnant again. She had gained more than 150 lb during her pregnancy and weighed 350 lb when she was admitted to the hospital for labor at 38.5 weeks’ gestation. She was seen by a resident who made a progress note that the mother “believed she was going to have a cesarean section.”
The on-call obstetrician reviewed the woman’s medical history and concluded from her previous pregnancies that the mother was going to have a normal-sized infant. Based on the risks of cesarean section in obese patients, the obstetrician attempted vaginal delivery.
An ultrasound was not performed and although the woman claimed to have received prenatal care, the prenatal doctor could not locate her records and denied he was her physician.
When vaginal delivery was not accomplished after 14 hours of labor and 3 hours of pushing, an emergency cesarean section was performed within a half hour. The infant, weighing 11 lb 8 oz, had hypoglycemia and remained in the hospital for 10 days.
The boy, now 19 years old, has an IQ of 50, which his mother claimed was a result of the trauma at birth and the hypoglycemia. The mother claimed that a cesarean section should have been performed sooner. The hospital denied any breach of standard care and argued that the absence of cerebral palsy meant that the retardation was likely genetic.
- The parties settled for $1 million.
A mother who had already delivered 5 infants weighing less than 8 lb each became pregnant again. She had gained more than 150 lb during her pregnancy and weighed 350 lb when she was admitted to the hospital for labor at 38.5 weeks’ gestation. She was seen by a resident who made a progress note that the mother “believed she was going to have a cesarean section.”
The on-call obstetrician reviewed the woman’s medical history and concluded from her previous pregnancies that the mother was going to have a normal-sized infant. Based on the risks of cesarean section in obese patients, the obstetrician attempted vaginal delivery.
An ultrasound was not performed and although the woman claimed to have received prenatal care, the prenatal doctor could not locate her records and denied he was her physician.
When vaginal delivery was not accomplished after 14 hours of labor and 3 hours of pushing, an emergency cesarean section was performed within a half hour. The infant, weighing 11 lb 8 oz, had hypoglycemia and remained in the hospital for 10 days.
The boy, now 19 years old, has an IQ of 50, which his mother claimed was a result of the trauma at birth and the hypoglycemia. The mother claimed that a cesarean section should have been performed sooner. The hospital denied any breach of standard care and argued that the absence of cerebral palsy meant that the retardation was likely genetic.
- The parties settled for $1 million.
A mother who had already delivered 5 infants weighing less than 8 lb each became pregnant again. She had gained more than 150 lb during her pregnancy and weighed 350 lb when she was admitted to the hospital for labor at 38.5 weeks’ gestation. She was seen by a resident who made a progress note that the mother “believed she was going to have a cesarean section.”
The on-call obstetrician reviewed the woman’s medical history and concluded from her previous pregnancies that the mother was going to have a normal-sized infant. Based on the risks of cesarean section in obese patients, the obstetrician attempted vaginal delivery.
An ultrasound was not performed and although the woman claimed to have received prenatal care, the prenatal doctor could not locate her records and denied he was her physician.
When vaginal delivery was not accomplished after 14 hours of labor and 3 hours of pushing, an emergency cesarean section was performed within a half hour. The infant, weighing 11 lb 8 oz, had hypoglycemia and remained in the hospital for 10 days.
The boy, now 19 years old, has an IQ of 50, which his mother claimed was a result of the trauma at birth and the hypoglycemia. The mother claimed that a cesarean section should have been performed sooner. The hospital denied any breach of standard care and argued that the absence of cerebral palsy meant that the retardation was likely genetic.
- The parties settled for $1 million.