Shoulder dystocia: Fundal pressure used?

Article Type
Changed
Tue, 08/28/2018 - 10:51
Display Headline
Shoulder dystocia: Fundal pressure used?

St. Louis (Mo) Circuit Court

When shoulder dystocia was encountered in the course of delivery, a clinician opted to use vacuum extraction, though the mother had pushed for just 16 minutes. The child was born with brachial plexus injury, which, despite subsequent surgery, left the affected arm 2 inches shorter than the uninjured arm, with partially limited function.

The plaintiff claimed vacuum extraction was used prematurely and contributed to the injury. She also argued that, per the delivery note, fundal pressure that was initiated prior to the dystocia was continued once the complication arose, when the clinician should have switched to suprapubic pressure.

The defense argued that a notation error was made in the delivery record, and that suprapubic pressure was indeed used.

  • 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.
Article PDF
Author and Disclosure Information

Issue
OBG Management - 17(05)
Publications
Topics
Page Number
83-90
Sections
Author and Disclosure Information

Author and Disclosure Information

Article PDF
Article PDF

St. Louis (Mo) Circuit Court

When shoulder dystocia was encountered in the course of delivery, a clinician opted to use vacuum extraction, though the mother had pushed for just 16 minutes. The child was born with brachial plexus injury, which, despite subsequent surgery, left the affected arm 2 inches shorter than the uninjured arm, with partially limited function.

The plaintiff claimed vacuum extraction was used prematurely and contributed to the injury. She also argued that, per the delivery note, fundal pressure that was initiated prior to the dystocia was continued once the complication arose, when the clinician should have switched to suprapubic pressure.

The defense argued that a notation error was made in the delivery record, and that suprapubic pressure was indeed used.

  • 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.

St. Louis (Mo) Circuit Court

When shoulder dystocia was encountered in the course of delivery, a clinician opted to use vacuum extraction, though the mother had pushed for just 16 minutes. The child was born with brachial plexus injury, which, despite subsequent surgery, left the affected arm 2 inches shorter than the uninjured arm, with partially limited function.

The plaintiff claimed vacuum extraction was used prematurely and contributed to the injury. She also argued that, per the delivery note, fundal pressure that was initiated prior to the dystocia was continued once the complication arose, when the clinician should have switched to suprapubic pressure.

The defense argued that a notation error was made in the delivery record, and that suprapubic pressure was indeed used.

  • 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.
Issue
OBG Management - 17(05)
Issue
OBG Management - 17(05)
Page Number
83-90
Page Number
83-90
Publications
Publications
Topics
Article Type
Display Headline
Shoulder dystocia: Fundal pressure used?
Display Headline
Shoulder dystocia: Fundal pressure used?
Sections
Article Source

PURLs Copyright

Inside the Article

Article PDF Media

Ureter injury follows unneeded hysterectomy

Article Type
Changed
Tue, 08/28/2018 - 10:51
Display Headline
Ureter injury follows unneeded hysterectomy

<court>Orange County (NY) Supreme Court</court>

With complaints of menorrhagia and dyspareunia, a 23-year-old woman with a previous tubal ligation presented to her Ob/Gyn. A course of oral contraceptives proved unsuccessful.

Ultrasound examination revealed an enlarged uterus. The physician informed the woman she had uterine fibroids and recommended a hysterectomy. At surgery, however, no fibroids were discovered. In the course of the procedure, the woman’s right ureter was severed. She developed a ureterovaginal fistula. Despite several corrective procedures, she claims to still suffer from urinary incontinence.

In suing, the plaintiff argued that the physician was negligent in not offering an alternative to hysterectomy, such as dilation and curettage.

The defendants maintained that the patient was fully informed, and argued that the hysterectomy was appropriate. Further, they noted that ureter injury is a known complication of the procedure, and alleged that the woman’s symptoms had resolved.

  • The jury awarded the plaintiff $600,000.

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.

Article PDF
Author and Disclosure Information

Issue
OBG Management - 17(05)
Publications
Topics
Page Number
83-90
Sections
Author and Disclosure Information

Author and Disclosure Information

Article PDF
Article PDF

<court>Orange County (NY) Supreme Court</court>

With complaints of menorrhagia and dyspareunia, a 23-year-old woman with a previous tubal ligation presented to her Ob/Gyn. A course of oral contraceptives proved unsuccessful.

Ultrasound examination revealed an enlarged uterus. The physician informed the woman she had uterine fibroids and recommended a hysterectomy. At surgery, however, no fibroids were discovered. In the course of the procedure, the woman’s right ureter was severed. She developed a ureterovaginal fistula. Despite several corrective procedures, she claims to still suffer from urinary incontinence.

In suing, the plaintiff argued that the physician was negligent in not offering an alternative to hysterectomy, such as dilation and curettage.

The defendants maintained that the patient was fully informed, and argued that the hysterectomy was appropriate. Further, they noted that ureter injury is a known complication of the procedure, and alleged that the woman’s symptoms had resolved.

  • The jury awarded the plaintiff $600,000.

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>Orange County (NY) Supreme Court</court>

With complaints of menorrhagia and dyspareunia, a 23-year-old woman with a previous tubal ligation presented to her Ob/Gyn. A course of oral contraceptives proved unsuccessful.

Ultrasound examination revealed an enlarged uterus. The physician informed the woman she had uterine fibroids and recommended a hysterectomy. At surgery, however, no fibroids were discovered. In the course of the procedure, the woman’s right ureter was severed. She developed a ureterovaginal fistula. Despite several corrective procedures, she claims to still suffer from urinary incontinence.

In suing, the plaintiff argued that the physician was negligent in not offering an alternative to hysterectomy, such as dilation and curettage.

The defendants maintained that the patient was fully informed, and argued that the hysterectomy was appropriate. Further, they noted that ureter injury is a known complication of the procedure, and alleged that the woman’s symptoms had resolved.

  • The jury awarded the plaintiff $600,000.

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.

Issue
OBG Management - 17(05)
Issue
OBG Management - 17(05)
Page Number
83-90
Page Number
83-90
Publications
Publications
Topics
Article Type
Display Headline
Ureter injury follows unneeded hysterectomy
Display Headline
Ureter injury follows unneeded hysterectomy
Sections
Article Source

PURLs Copyright

Inside the Article

Article PDF Media

Was infant’s death “no serious harm”?

Article Type
Changed
Tue, 08/28/2018 - 10:51
Display Headline
Was infant’s death “no serious harm”?

Palm Beach County (Fla) Circuit Court

A gravida with a high-risk pregnancy presented to a hospital with preterm premature rupture of membranes (PPROM), but was discharged home without delivery of her child.

She returned a few days later still leaking amniotic fluid, but was not examined by the defendant physician. Though fetal monitor records had been lost by the time of trial, a nurse’s notes indicate a problematic fetal heart rate—but also state that the defendant was not informed of this development.

The child, born with brain damage, died 1 week after birth.

In suing, the plaintiff alleged negligence in the delayed delivery of her child.

The defendant, who did not have liability insurance, chose not to defend the liability suit, leading to a default judgment. She did defend the damages claim, however, arguing that the plaintiff did not suffer serious harm, as she already had another child.

  • The jury awarded the plaintiff $5 million for pain and suffering.
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.
Article PDF
Author and Disclosure Information

Issue
OBG Management - 17(05)
Publications
Topics
Page Number
83-90
Sections
Author and Disclosure Information

Author and Disclosure Information

Article PDF
Article PDF

Palm Beach County (Fla) Circuit Court

A gravida with a high-risk pregnancy presented to a hospital with preterm premature rupture of membranes (PPROM), but was discharged home without delivery of her child.

She returned a few days later still leaking amniotic fluid, but was not examined by the defendant physician. Though fetal monitor records had been lost by the time of trial, a nurse’s notes indicate a problematic fetal heart rate—but also state that the defendant was not informed of this development.

The child, born with brain damage, died 1 week after birth.

In suing, the plaintiff alleged negligence in the delayed delivery of her child.

The defendant, who did not have liability insurance, chose not to defend the liability suit, leading to a default judgment. She did defend the damages claim, however, arguing that the plaintiff did not suffer serious harm, as she already had another child.

  • The jury awarded the plaintiff $5 million for pain and suffering.
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.

Palm Beach County (Fla) Circuit Court

A gravida with a high-risk pregnancy presented to a hospital with preterm premature rupture of membranes (PPROM), but was discharged home without delivery of her child.

She returned a few days later still leaking amniotic fluid, but was not examined by the defendant physician. Though fetal monitor records had been lost by the time of trial, a nurse’s notes indicate a problematic fetal heart rate—but also state that the defendant was not informed of this development.

The child, born with brain damage, died 1 week after birth.

In suing, the plaintiff alleged negligence in the delayed delivery of her child.

The defendant, who did not have liability insurance, chose not to defend the liability suit, leading to a default judgment. She did defend the damages claim, however, arguing that the plaintiff did not suffer serious harm, as she already had another child.

  • The jury awarded the plaintiff $5 million for pain and suffering.
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.
Issue
OBG Management - 17(05)
Issue
OBG Management - 17(05)
Page Number
83-90
Page Number
83-90
Publications
Publications
Topics
Article Type
Display Headline
Was infant’s death “no serious harm”?
Display Headline
Was infant’s death “no serious harm”?
Sections
Article Source

PURLs Copyright

Inside the Article

Article PDF Media

Minilaparotomy code depends on incision

Article Type
Changed
Tue, 08/28/2018 - 10:50
Display Headline
Minilaparotomy code depends on incision

Q A new doctor in our practice performed a minilaparotomy with ovarian cystectomy. Since none of our other physicians use this approach, I’m not sure how to code. Any pointers?

A It depends on what you mean by minilaparotomy. In some procedures the incision is small, but it is still an abdominal incision. In others, a “Hasson” or “open field” technique is used, with a small incision to direct the trocar into the correct position. In this case, CPT previously directed coders to add modifier –22 to the primary laparoscopic procedure. (These instructions appeared in CPT as a note before the laparoscopic procedures were distributed throughout the CPT book.)

However, if your physician always uses this technique for performing laparoscopy, the payer will ignore the –22 modifier.

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.

Article PDF
Author and Disclosure Information

Melanie Witt, RN, CPC, MA

Issue
OBG Management - 17(05)
Publications
Topics
Page Number
79-80
Sections
Author and Disclosure Information

Melanie Witt, RN, CPC, MA

Author and Disclosure Information

Melanie Witt, RN, CPC, MA

Article PDF
Article PDF

Q A new doctor in our practice performed a minilaparotomy with ovarian cystectomy. Since none of our other physicians use this approach, I’m not sure how to code. Any pointers?

A It depends on what you mean by minilaparotomy. In some procedures the incision is small, but it is still an abdominal incision. In others, a “Hasson” or “open field” technique is used, with a small incision to direct the trocar into the correct position. In this case, CPT previously directed coders to add modifier –22 to the primary laparoscopic procedure. (These instructions appeared in CPT as a note before the laparoscopic procedures were distributed throughout the CPT book.)

However, if your physician always uses this technique for performing laparoscopy, the payer will ignore the –22 modifier.

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.

Q A new doctor in our practice performed a minilaparotomy with ovarian cystectomy. Since none of our other physicians use this approach, I’m not sure how to code. Any pointers?

A It depends on what you mean by minilaparotomy. In some procedures the incision is small, but it is still an abdominal incision. In others, a “Hasson” or “open field” technique is used, with a small incision to direct the trocar into the correct position. In this case, CPT previously directed coders to add modifier –22 to the primary laparoscopic procedure. (These instructions appeared in CPT as a note before the laparoscopic procedures were distributed throughout the CPT book.)

However, if your physician always uses this technique for performing laparoscopy, the payer will ignore the –22 modifier.

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.

Issue
OBG Management - 17(05)
Issue
OBG Management - 17(05)
Page Number
79-80
Page Number
79-80
Publications
Publications
Topics
Article Type
Display Headline
Minilaparotomy code depends on incision
Display Headline
Minilaparotomy code depends on incision
Sections
Article Source

PURLs Copyright

OBG Management ©2005 Dowden Health Media

Inside the Article

Article PDF Media

New laparoscopic code on the way

Article Type
Changed
Tue, 08/28/2018 - 10:50
Display Headline
New laparoscopic code on the way

Q What code should I use for laparoscopic supracervical hysterectomy? Code 58180 appears to be intended for the abdominal approach.

A CPT rules clearly forbid billing a laparoscopic procedure using a code for the abdominal approach. This leaves you with 2 options: Either use

  • existing laparoscopically assisted vaginal hysterectomy codes (58550– 58554) with modifier –52 added to denote a reduced service because the cervix was not removed, or
  • unlisted laparoscopy code 58579.

ACOG is working on new codes for laparoscopic supracervical hysterectomy.

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.

Article PDF
Author and Disclosure Information

Melanie Witt, RN, CPC, MA

Issue
OBG Management - 17(05)
Publications
Topics
Page Number
79-80
Sections
Author and Disclosure Information

Melanie Witt, RN, CPC, MA

Author and Disclosure Information

Melanie Witt, RN, CPC, MA

Article PDF
Article PDF

Q What code should I use for laparoscopic supracervical hysterectomy? Code 58180 appears to be intended for the abdominal approach.

A CPT rules clearly forbid billing a laparoscopic procedure using a code for the abdominal approach. This leaves you with 2 options: Either use

  • existing laparoscopically assisted vaginal hysterectomy codes (58550– 58554) with modifier –52 added to denote a reduced service because the cervix was not removed, or
  • unlisted laparoscopy code 58579.

ACOG is working on new codes for laparoscopic supracervical hysterectomy.

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.

Q What code should I use for laparoscopic supracervical hysterectomy? Code 58180 appears to be intended for the abdominal approach.

A CPT rules clearly forbid billing a laparoscopic procedure using a code for the abdominal approach. This leaves you with 2 options: Either use

  • existing laparoscopically assisted vaginal hysterectomy codes (58550– 58554) with modifier –52 added to denote a reduced service because the cervix was not removed, or
  • unlisted laparoscopy code 58579.

ACOG is working on new codes for laparoscopic supracervical hysterectomy.

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.

Issue
OBG Management - 17(05)
Issue
OBG Management - 17(05)
Page Number
79-80
Page Number
79-80
Publications
Publications
Topics
Article Type
Display Headline
New laparoscopic code on the way
Display Headline
New laparoscopic code on the way
Sections
Article Source

PURLs Copyright

OBG Management ©2005 Dowden Health Media

Inside the Article

Article PDF Media

Limits to NSTs?

Article Type
Changed
Tue, 08/28/2018 - 10:50
Display Headline
Limits to NSTs?

Q A patient was admitted to a hospital at 37 weeks’ gestation for preterm labor. She stayed 15 days but did not deliver.

Can the attending physician charge outside the global fee for interpreting non-stress tests (NSTs) during this period? If so, how many readings a day can be billed?

A At 37 weeks, the patient does not have premature labor (644.0x), but “other threatened labor,” which is ICD-9 code 644.13 if she does not go on to deliver during this hospitalization. The physician can bill for the admission and daily rounding, but billing for the NST will depend on whether one was performed.

To bill for 59025, the patient is required to mark the strip to indicate fetal movements throughout the 30 to 40 minutes of the test. It would only be necessary to do so if the physician suspected a fetal problem.

However, if external fetal monitors are being used to count contractions or monitor heart rate, the NST would be billed as part of the exam.

No Limit on Number of Tests, If Medically Needed

If a true NST is performed and documented and the physician has interpreted the results, then the obstetrician can bill for it using 59025–59026. No protocols stipulate a limit for NSTs in a single day, but the payer will likely ask about medical necessity if more than 1 per day is performed—especially if the results are all reassuring and the patient is close to term.

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.

Article PDF
Author and Disclosure Information

Melanie Witt, RN, CPC, MA

Issue
OBG Management - 17(05)
Publications
Page Number
79-80
Sections
Author and Disclosure Information

Melanie Witt, RN, CPC, MA

Author and Disclosure Information

Melanie Witt, RN, CPC, MA

Article PDF
Article PDF

Q A patient was admitted to a hospital at 37 weeks’ gestation for preterm labor. She stayed 15 days but did not deliver.

Can the attending physician charge outside the global fee for interpreting non-stress tests (NSTs) during this period? If so, how many readings a day can be billed?

A At 37 weeks, the patient does not have premature labor (644.0x), but “other threatened labor,” which is ICD-9 code 644.13 if she does not go on to deliver during this hospitalization. The physician can bill for the admission and daily rounding, but billing for the NST will depend on whether one was performed.

To bill for 59025, the patient is required to mark the strip to indicate fetal movements throughout the 30 to 40 minutes of the test. It would only be necessary to do so if the physician suspected a fetal problem.

However, if external fetal monitors are being used to count contractions or monitor heart rate, the NST would be billed as part of the exam.

No Limit on Number of Tests, If Medically Needed

If a true NST is performed and documented and the physician has interpreted the results, then the obstetrician can bill for it using 59025–59026. No protocols stipulate a limit for NSTs in a single day, but the payer will likely ask about medical necessity if more than 1 per day is performed—especially if the results are all reassuring and the patient is close to term.

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.

Q A patient was admitted to a hospital at 37 weeks’ gestation for preterm labor. She stayed 15 days but did not deliver.

Can the attending physician charge outside the global fee for interpreting non-stress tests (NSTs) during this period? If so, how many readings a day can be billed?

A At 37 weeks, the patient does not have premature labor (644.0x), but “other threatened labor,” which is ICD-9 code 644.13 if she does not go on to deliver during this hospitalization. The physician can bill for the admission and daily rounding, but billing for the NST will depend on whether one was performed.

To bill for 59025, the patient is required to mark the strip to indicate fetal movements throughout the 30 to 40 minutes of the test. It would only be necessary to do so if the physician suspected a fetal problem.

However, if external fetal monitors are being used to count contractions or monitor heart rate, the NST would be billed as part of the exam.

No Limit on Number of Tests, If Medically Needed

If a true NST is performed and documented and the physician has interpreted the results, then the obstetrician can bill for it using 59025–59026. No protocols stipulate a limit for NSTs in a single day, but the payer will likely ask about medical necessity if more than 1 per day is performed—especially if the results are all reassuring and the patient is close to term.

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.

Issue
OBG Management - 17(05)
Issue
OBG Management - 17(05)
Page Number
79-80
Page Number
79-80
Publications
Publications
Article Type
Display Headline
Limits to NSTs?
Display Headline
Limits to NSTs?
Sections
Article Source

PURLs Copyright

OBG Management ©2005 Dowden Health Media

Inside the Article

Article PDF Media

A consult calls for more expertise, not less

Article Type
Changed
Tue, 08/28/2018 - 10:50
Display Headline
A consult calls for more expertise, not less

Q A patient was sent to a midwife by the physician managing her pregnancy. She was sent to obtain information on midwifery so she could decide whether to transfer care.

Can this visit be billed as a consultation, since the physician asked the midwife to see the patient?

A No. A consultation happens when a physician or other health-care professional asks a physician for an opinion or advice about the patient’s condition. Because a midwife has less training than a physician, a midwife is not allowed to bill for a consultation if asked to see a patient at an MD’s request. Remember, the idea behind the consult is to send the patient to someone with more expertise, not less.

It Was Counseling, Not Consulting

Further, the reason for the patient’s visit was not to seek the midwife’s opinion or advice about the patient’s condition. Rather, the midwife was asked to give the patient information, which is “counseling,” not “consulting.”

In this case, the payer may reimburse the midwife for an evaluation and management (E/M) service. Once the patient becomes an established patient for the pregnancy, the midwife will report the applicable maternity care code(s) for transfer of care for a portion of the pregnancy (eg, 59426 with 59410).

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.

Article PDF
Author and Disclosure Information

Melanie Witt, RN, CPC, MA

Issue
OBG Management - 17(05)
Publications
Topics
Page Number
79-80
Sections
Author and Disclosure Information

Melanie Witt, RN, CPC, MA

Author and Disclosure Information

Melanie Witt, RN, CPC, MA

Article PDF
Article PDF

Q A patient was sent to a midwife by the physician managing her pregnancy. She was sent to obtain information on midwifery so she could decide whether to transfer care.

Can this visit be billed as a consultation, since the physician asked the midwife to see the patient?

A No. A consultation happens when a physician or other health-care professional asks a physician for an opinion or advice about the patient’s condition. Because a midwife has less training than a physician, a midwife is not allowed to bill for a consultation if asked to see a patient at an MD’s request. Remember, the idea behind the consult is to send the patient to someone with more expertise, not less.

It Was Counseling, Not Consulting

Further, the reason for the patient’s visit was not to seek the midwife’s opinion or advice about the patient’s condition. Rather, the midwife was asked to give the patient information, which is “counseling,” not “consulting.”

In this case, the payer may reimburse the midwife for an evaluation and management (E/M) service. Once the patient becomes an established patient for the pregnancy, the midwife will report the applicable maternity care code(s) for transfer of care for a portion of the pregnancy (eg, 59426 with 59410).

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.

Q A patient was sent to a midwife by the physician managing her pregnancy. She was sent to obtain information on midwifery so she could decide whether to transfer care.

Can this visit be billed as a consultation, since the physician asked the midwife to see the patient?

A No. A consultation happens when a physician or other health-care professional asks a physician for an opinion or advice about the patient’s condition. Because a midwife has less training than a physician, a midwife is not allowed to bill for a consultation if asked to see a patient at an MD’s request. Remember, the idea behind the consult is to send the patient to someone with more expertise, not less.

It Was Counseling, Not Consulting

Further, the reason for the patient’s visit was not to seek the midwife’s opinion or advice about the patient’s condition. Rather, the midwife was asked to give the patient information, which is “counseling,” not “consulting.”

In this case, the payer may reimburse the midwife for an evaluation and management (E/M) service. Once the patient becomes an established patient for the pregnancy, the midwife will report the applicable maternity care code(s) for transfer of care for a portion of the pregnancy (eg, 59426 with 59410).

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.

Issue
OBG Management - 17(05)
Issue
OBG Management - 17(05)
Page Number
79-80
Page Number
79-80
Publications
Publications
Topics
Article Type
Display Headline
A consult calls for more expertise, not less
Display Headline
A consult calls for more expertise, not less
Sections
Article Source

PURLs Copyright

OBG Management ©2005 Dowden Health Media

Inside the Article

Article PDF Media

Insurer won’t pay for routine lab tests

Article Type
Changed
Tue, 08/28/2018 - 10:50
Display Headline
Insurer won’t pay for routine lab tests

Q When we bill for Pap tests (Q0091), vaginal cultures (87070), and stool guaiac (82270), insurance companies refuse to pay.

They tell me we can collect for obtaining the specimen, but I cannot find the correct CPT codes. How should I proceed?

A It depends on what payer you are billing and whether you have the correct Clinical Laboratories Improvement Act (CLIA) certificate to bill for laboratory procedures.

The code Q0091 was developed by Medicare to reimburse physicians for collecting a Pap smear at the time of an otherwise noncovered service. When they later added the code G0101 for the pelvic and breast exam portion of a preventive visit, they continued to reimburse for the collection as well.

Collection Codes

This collection code is not recognized by all payers, however. In fact, the American College of Obstetricians and Gynecologists (ACOG) has indicated that collection is part of the exam and not a separately billable service. However, some payers will allow you to collect for handling the specimen by using the code 99000.

Lab Codes

As for the lab tests you are billing, all providers are required to have the proper certificate before they can bill for laboratory tests. By billing the lab codes, you are telling the payer you are qualified to perform these tests and that you did, in fact, perform them. Once again, there is no collection code for either of these tests. Code 82270, which is a waived test, can be performed by the physician in the office, and the collection of the stool specimen is an integral part of the code. A waived test, by the way, still requires a certificate (visit www.cms.hhs.gov/clia/certypes.asp for definitions of the various certificate levels).

Culture Codes

The culture code you are using, 87070, is considered a highly complex test for which the highest certificate level would be required. Again, there is no collection code for the vaginal specimen, but you might be able to bill 99000 for the handling. If the Pap smear and culture collection are performed at the same visit, you would only bill 99000 once.

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.

Article PDF
Author and Disclosure Information

Melanie Witt, RN, CPC, MA

Issue
OBG Management - 17(05)
Publications
Topics
Page Number
79-80
Sections
Author and Disclosure Information

Melanie Witt, RN, CPC, MA

Author and Disclosure Information

Melanie Witt, RN, CPC, MA

Article PDF
Article PDF

Q When we bill for Pap tests (Q0091), vaginal cultures (87070), and stool guaiac (82270), insurance companies refuse to pay.

They tell me we can collect for obtaining the specimen, but I cannot find the correct CPT codes. How should I proceed?

A It depends on what payer you are billing and whether you have the correct Clinical Laboratories Improvement Act (CLIA) certificate to bill for laboratory procedures.

The code Q0091 was developed by Medicare to reimburse physicians for collecting a Pap smear at the time of an otherwise noncovered service. When they later added the code G0101 for the pelvic and breast exam portion of a preventive visit, they continued to reimburse for the collection as well.

Collection Codes

This collection code is not recognized by all payers, however. In fact, the American College of Obstetricians and Gynecologists (ACOG) has indicated that collection is part of the exam and not a separately billable service. However, some payers will allow you to collect for handling the specimen by using the code 99000.

Lab Codes

As for the lab tests you are billing, all providers are required to have the proper certificate before they can bill for laboratory tests. By billing the lab codes, you are telling the payer you are qualified to perform these tests and that you did, in fact, perform them. Once again, there is no collection code for either of these tests. Code 82270, which is a waived test, can be performed by the physician in the office, and the collection of the stool specimen is an integral part of the code. A waived test, by the way, still requires a certificate (visit www.cms.hhs.gov/clia/certypes.asp for definitions of the various certificate levels).

Culture Codes

The culture code you are using, 87070, is considered a highly complex test for which the highest certificate level would be required. Again, there is no collection code for the vaginal specimen, but you might be able to bill 99000 for the handling. If the Pap smear and culture collection are performed at the same visit, you would only bill 99000 once.

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.

Q When we bill for Pap tests (Q0091), vaginal cultures (87070), and stool guaiac (82270), insurance companies refuse to pay.

They tell me we can collect for obtaining the specimen, but I cannot find the correct CPT codes. How should I proceed?

A It depends on what payer you are billing and whether you have the correct Clinical Laboratories Improvement Act (CLIA) certificate to bill for laboratory procedures.

The code Q0091 was developed by Medicare to reimburse physicians for collecting a Pap smear at the time of an otherwise noncovered service. When they later added the code G0101 for the pelvic and breast exam portion of a preventive visit, they continued to reimburse for the collection as well.

Collection Codes

This collection code is not recognized by all payers, however. In fact, the American College of Obstetricians and Gynecologists (ACOG) has indicated that collection is part of the exam and not a separately billable service. However, some payers will allow you to collect for handling the specimen by using the code 99000.

Lab Codes

As for the lab tests you are billing, all providers are required to have the proper certificate before they can bill for laboratory tests. By billing the lab codes, you are telling the payer you are qualified to perform these tests and that you did, in fact, perform them. Once again, there is no collection code for either of these tests. Code 82270, which is a waived test, can be performed by the physician in the office, and the collection of the stool specimen is an integral part of the code. A waived test, by the way, still requires a certificate (visit www.cms.hhs.gov/clia/certypes.asp for definitions of the various certificate levels).

Culture Codes

The culture code you are using, 87070, is considered a highly complex test for which the highest certificate level would be required. Again, there is no collection code for the vaginal specimen, but you might be able to bill 99000 for the handling. If the Pap smear and culture collection are performed at the same visit, you would only bill 99000 once.

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.

Issue
OBG Management - 17(05)
Issue
OBG Management - 17(05)
Page Number
79-80
Page Number
79-80
Publications
Publications
Topics
Article Type
Display Headline
Insurer won’t pay for routine lab tests
Display Headline
Insurer won’t pay for routine lab tests
Sections
Article Source

PURLs Copyright

OBG Management ©2005 Dowden Health Media

Inside the Article

Article PDF Media

How to Run Effective Office Meetings

Article Type
Changed
Fri, 01/11/2019 - 09:48
Display Headline
How to Run Effective Office Meetings

“What do you discuss at office meetings?” a colleague wrote me recently. “We used to hold them monthly, and I never thought we accomplished anything. So now we don't bother anymore.”

It's a comment I hear fairly often. Doctors and employees alike frequently dread staff meetings. Four common complaints about them are: Too much time is spent dwelling on trivia with no time left to address important problems; any important issues that do get covered are seldom if ever resolved; no one acts on any constructive suggestions made; and all too often they degenerate into petty gripe sessions. The problem, though, is not with meetings themselves, but with improper (or complete lack of) planning. Avoiding meetings is not the answer; structuring them effectively is.

First, call meetings only when necessary. No rule says you must have one every month if there are no issues worth meeting about, or that you must wait until the next month if an urgent problem arises. My office manager keeps a list of “meeting topics” contributed by everyone in the office. When she accumulates enough to warrant a meeting (from three to six, depending on their complexity), she calls one.

She then prepares an agenda, ranking the topics of discussion in order of importance, and determines whether the meeting will require attendance by the entire staff or certain subgroups only. I am a firm believer in including at least one “positive” item in every agenda. Most meetings are grim affairs that deal exclusively with problems needing fixing, and that contributes significantly to the hatred most people have for them. Positive items may include recognition of specific professional or personal achievements, displays of photos of new babies or pets, examples of positive patient feedback, etc.

The agenda should be typed and distributed in advance of the meeting to all staff members who will be expected to attend it, to allow them time to prepare questions, comments, and suggestions.

Put the phones on service. Order in lunch if the meeting is at lunchtime, refreshments if not. Start on time. Waiting for latecomers penalizes those who have been courteous enough to be prompt. Stay on time and end on time.

The primary objective of the meeting itself should be to follow a well-planned agenda. Assign someone to keep everyone on track and make sure all agenda items are addressed.

Someone else should take notes summarizing each agenda item, any and all suggestions for resolving the issues raised, and proposed strategies for implementing those suggestions.

Allocate a specific amount of time for each item. A common problem is failure to get through the entire agenda. Stay on track, and don't get stuck on any one problem. If you can't resolve an issue in the allotted time, make a note to continue discussion at the next meeting, or appoint a “task force” to study the problem and report back at the next meeting.

All of the above is for naught, however, without follow-up. Within a day or 2 of the meeting, your manager should distribute a written follow-up document outlining the agenda items covered, proposed solutions, tasks assigned toward accomplishing those solutions, and deadlines for each task.

This last is most important. Someone once wrote, “a task without a deadline is only a discussion.” Without a completion date in mind, the assignment may never even begin. A deadline emphasizes not only the importance, but also the urgency of the action that needs to be taken.

Running well-structured, effective meetings is a bit difficult at first, but the more you do it the easier it gets. And it provides a good foundation for a policy of open and honest communication that is a vital part of any efficient practice.

Article PDF
Author and Disclosure Information

Publications
Sections
Author and Disclosure Information

Author and Disclosure Information

Article PDF
Article PDF

“What do you discuss at office meetings?” a colleague wrote me recently. “We used to hold them monthly, and I never thought we accomplished anything. So now we don't bother anymore.”

It's a comment I hear fairly often. Doctors and employees alike frequently dread staff meetings. Four common complaints about them are: Too much time is spent dwelling on trivia with no time left to address important problems; any important issues that do get covered are seldom if ever resolved; no one acts on any constructive suggestions made; and all too often they degenerate into petty gripe sessions. The problem, though, is not with meetings themselves, but with improper (or complete lack of) planning. Avoiding meetings is not the answer; structuring them effectively is.

First, call meetings only when necessary. No rule says you must have one every month if there are no issues worth meeting about, or that you must wait until the next month if an urgent problem arises. My office manager keeps a list of “meeting topics” contributed by everyone in the office. When she accumulates enough to warrant a meeting (from three to six, depending on their complexity), she calls one.

She then prepares an agenda, ranking the topics of discussion in order of importance, and determines whether the meeting will require attendance by the entire staff or certain subgroups only. I am a firm believer in including at least one “positive” item in every agenda. Most meetings are grim affairs that deal exclusively with problems needing fixing, and that contributes significantly to the hatred most people have for them. Positive items may include recognition of specific professional or personal achievements, displays of photos of new babies or pets, examples of positive patient feedback, etc.

The agenda should be typed and distributed in advance of the meeting to all staff members who will be expected to attend it, to allow them time to prepare questions, comments, and suggestions.

Put the phones on service. Order in lunch if the meeting is at lunchtime, refreshments if not. Start on time. Waiting for latecomers penalizes those who have been courteous enough to be prompt. Stay on time and end on time.

The primary objective of the meeting itself should be to follow a well-planned agenda. Assign someone to keep everyone on track and make sure all agenda items are addressed.

Someone else should take notes summarizing each agenda item, any and all suggestions for resolving the issues raised, and proposed strategies for implementing those suggestions.

Allocate a specific amount of time for each item. A common problem is failure to get through the entire agenda. Stay on track, and don't get stuck on any one problem. If you can't resolve an issue in the allotted time, make a note to continue discussion at the next meeting, or appoint a “task force” to study the problem and report back at the next meeting.

All of the above is for naught, however, without follow-up. Within a day or 2 of the meeting, your manager should distribute a written follow-up document outlining the agenda items covered, proposed solutions, tasks assigned toward accomplishing those solutions, and deadlines for each task.

This last is most important. Someone once wrote, “a task without a deadline is only a discussion.” Without a completion date in mind, the assignment may never even begin. A deadline emphasizes not only the importance, but also the urgency of the action that needs to be taken.

Running well-structured, effective meetings is a bit difficult at first, but the more you do it the easier it gets. And it provides a good foundation for a policy of open and honest communication that is a vital part of any efficient practice.

“What do you discuss at office meetings?” a colleague wrote me recently. “We used to hold them monthly, and I never thought we accomplished anything. So now we don't bother anymore.”

It's a comment I hear fairly often. Doctors and employees alike frequently dread staff meetings. Four common complaints about them are: Too much time is spent dwelling on trivia with no time left to address important problems; any important issues that do get covered are seldom if ever resolved; no one acts on any constructive suggestions made; and all too often they degenerate into petty gripe sessions. The problem, though, is not with meetings themselves, but with improper (or complete lack of) planning. Avoiding meetings is not the answer; structuring them effectively is.

First, call meetings only when necessary. No rule says you must have one every month if there are no issues worth meeting about, or that you must wait until the next month if an urgent problem arises. My office manager keeps a list of “meeting topics” contributed by everyone in the office. When she accumulates enough to warrant a meeting (from three to six, depending on their complexity), she calls one.

She then prepares an agenda, ranking the topics of discussion in order of importance, and determines whether the meeting will require attendance by the entire staff or certain subgroups only. I am a firm believer in including at least one “positive” item in every agenda. Most meetings are grim affairs that deal exclusively with problems needing fixing, and that contributes significantly to the hatred most people have for them. Positive items may include recognition of specific professional or personal achievements, displays of photos of new babies or pets, examples of positive patient feedback, etc.

The agenda should be typed and distributed in advance of the meeting to all staff members who will be expected to attend it, to allow them time to prepare questions, comments, and suggestions.

Put the phones on service. Order in lunch if the meeting is at lunchtime, refreshments if not. Start on time. Waiting for latecomers penalizes those who have been courteous enough to be prompt. Stay on time and end on time.

The primary objective of the meeting itself should be to follow a well-planned agenda. Assign someone to keep everyone on track and make sure all agenda items are addressed.

Someone else should take notes summarizing each agenda item, any and all suggestions for resolving the issues raised, and proposed strategies for implementing those suggestions.

Allocate a specific amount of time for each item. A common problem is failure to get through the entire agenda. Stay on track, and don't get stuck on any one problem. If you can't resolve an issue in the allotted time, make a note to continue discussion at the next meeting, or appoint a “task force” to study the problem and report back at the next meeting.

All of the above is for naught, however, without follow-up. Within a day or 2 of the meeting, your manager should distribute a written follow-up document outlining the agenda items covered, proposed solutions, tasks assigned toward accomplishing those solutions, and deadlines for each task.

This last is most important. Someone once wrote, “a task without a deadline is only a discussion.” Without a completion date in mind, the assignment may never even begin. A deadline emphasizes not only the importance, but also the urgency of the action that needs to be taken.

Running well-structured, effective meetings is a bit difficult at first, but the more you do it the easier it gets. And it provides a good foundation for a policy of open and honest communication that is a vital part of any efficient practice.

Publications
Publications
Article Type
Display Headline
How to Run Effective Office Meetings
Display Headline
How to Run Effective Office Meetings
Sections
Article Source

PURLs Copyright

Inside the Article

Article PDF Media

Was fetal presentation compound?

Article Type
Changed
Tue, 08/28/2018 - 10:50
Display Headline
Was fetal presentation compound?

Westchester County (NY) Supreme Court

Shortly after discharge following delivery and tubal ligation, a woman brought her newborn infant to a pediatrician. The physician suggested she take the child to an orthopedic surgeon, who diagnosed brachial plexus injury and Erb’s palsy. Surgery was required to repair the child’s cosmetic deformities, but full range of motion could not be recovered.

In suing, the plaintiff claimed the Ob/Gyn failed to recognize a compound presentation—which was noted by a delivery nurse—and applied excessive traction to the head and brachial plexus. She claimed the physician was further negligent in failing to recognize the injury.

The mother noted that, due to her tubal ligation procedure, she saw the infant very little prior to discharge, and only when the child was wrapped in a blanket. Thus, she did not notice any abnormalities before her release.

The obstetrician denied a compound presentation, maintained delivery was uncomplicated, and contended the child was in good condition at discharge.

  • 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.
Article PDF
Author and Disclosure Information

Issue
OBG Management - 17(04)
Publications
Topics
Page Number
92-94
Sections
Author and Disclosure Information

Author and Disclosure Information

Article PDF
Article PDF

Westchester County (NY) Supreme Court

Shortly after discharge following delivery and tubal ligation, a woman brought her newborn infant to a pediatrician. The physician suggested she take the child to an orthopedic surgeon, who diagnosed brachial plexus injury and Erb’s palsy. Surgery was required to repair the child’s cosmetic deformities, but full range of motion could not be recovered.

In suing, the plaintiff claimed the Ob/Gyn failed to recognize a compound presentation—which was noted by a delivery nurse—and applied excessive traction to the head and brachial plexus. She claimed the physician was further negligent in failing to recognize the injury.

The mother noted that, due to her tubal ligation procedure, she saw the infant very little prior to discharge, and only when the child was wrapped in a blanket. Thus, she did not notice any abnormalities before her release.

The obstetrician denied a compound presentation, maintained delivery was uncomplicated, and contended the child was in good condition at discharge.

  • 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.

Westchester County (NY) Supreme Court

Shortly after discharge following delivery and tubal ligation, a woman brought her newborn infant to a pediatrician. The physician suggested she take the child to an orthopedic surgeon, who diagnosed brachial plexus injury and Erb’s palsy. Surgery was required to repair the child’s cosmetic deformities, but full range of motion could not be recovered.

In suing, the plaintiff claimed the Ob/Gyn failed to recognize a compound presentation—which was noted by a delivery nurse—and applied excessive traction to the head and brachial plexus. She claimed the physician was further negligent in failing to recognize the injury.

The mother noted that, due to her tubal ligation procedure, she saw the infant very little prior to discharge, and only when the child was wrapped in a blanket. Thus, she did not notice any abnormalities before her release.

The obstetrician denied a compound presentation, maintained delivery was uncomplicated, and contended the child was in good condition at discharge.

  • 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.
Issue
OBG Management - 17(04)
Issue
OBG Management - 17(04)
Page Number
92-94
Page Number
92-94
Publications
Publications
Topics
Article Type
Display Headline
Was fetal presentation compound?
Display Headline
Was fetal presentation compound?
Sections
Article Source

PURLs Copyright

Inside the Article

Article PDF Media