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Did flawed clamping lead to cerebral palsy?
A woman delivered an infant girl, who soon after birth went into hypovolemic shock. She was immediately brought to intensive care, but now suffers cerebral palsy, quadriparesis, and mental retardation.
The plaintiff claimed physicians did not adequately clamp the umbilical cord before it was cut; this led to bleeding from the cord and, ultimately, the hypovolemia that caused her current condition.
The defense contended bleeding at birth was minimal and the child’s injuries stemmed from an intrauterine condition.
- The case settled for $4.8 million.
A woman delivered an infant girl, who soon after birth went into hypovolemic shock. She was immediately brought to intensive care, but now suffers cerebral palsy, quadriparesis, and mental retardation.
The plaintiff claimed physicians did not adequately clamp the umbilical cord before it was cut; this led to bleeding from the cord and, ultimately, the hypovolemia that caused her current condition.
The defense contended bleeding at birth was minimal and the child’s injuries stemmed from an intrauterine condition.
- The case settled for $4.8 million.
A woman delivered an infant girl, who soon after birth went into hypovolemic shock. She was immediately brought to intensive care, but now suffers cerebral palsy, quadriparesis, and mental retardation.
The plaintiff claimed physicians did not adequately clamp the umbilical cord before it was cut; this led to bleeding from the cord and, ultimately, the hypovolemia that caused her current condition.
The defense contended bleeding at birth was minimal and the child’s injuries stemmed from an intrauterine condition.
- The case settled for $4.8 million.
Cesarean was delayed for elective procedure
On Thanksgiving Day, an Ob/Gyn performed an elective tubal ligation in the only operating room in the hospital’s labor and delivery suite. Prior to the procedure’s start, fetal monitoring on a laboring woman showed minimal variability and variable decelerations. This trend persisted for 2 hours and then worsened. Nurses later discovered a prolapsed umbilical cord.
It took hospital staff 20 minutes to secure an operating room and appropriate surgical staff. The child, born via emergency cesarean, suffered brain damage leading to cerebral palsy, spastic quadriparesis, and an inability to walk or talk.
The defense denied negligence, maintaining the child had a preexisting fetal inflammatory response syndrome.
- The Ob/Gyn settled for $1.5 million. The jury awarded the plaintiff $12.5 million against the hospital.
On Thanksgiving Day, an Ob/Gyn performed an elective tubal ligation in the only operating room in the hospital’s labor and delivery suite. Prior to the procedure’s start, fetal monitoring on a laboring woman showed minimal variability and variable decelerations. This trend persisted for 2 hours and then worsened. Nurses later discovered a prolapsed umbilical cord.
It took hospital staff 20 minutes to secure an operating room and appropriate surgical staff. The child, born via emergency cesarean, suffered brain damage leading to cerebral palsy, spastic quadriparesis, and an inability to walk or talk.
The defense denied negligence, maintaining the child had a preexisting fetal inflammatory response syndrome.
- The Ob/Gyn settled for $1.5 million. The jury awarded the plaintiff $12.5 million against the hospital.
On Thanksgiving Day, an Ob/Gyn performed an elective tubal ligation in the only operating room in the hospital’s labor and delivery suite. Prior to the procedure’s start, fetal monitoring on a laboring woman showed minimal variability and variable decelerations. This trend persisted for 2 hours and then worsened. Nurses later discovered a prolapsed umbilical cord.
It took hospital staff 20 minutes to secure an operating room and appropriate surgical staff. The child, born via emergency cesarean, suffered brain damage leading to cerebral palsy, spastic quadriparesis, and an inability to walk or talk.
The defense denied negligence, maintaining the child had a preexisting fetal inflammatory response syndrome.
- The Ob/Gyn settled for $1.5 million. The jury awarded the plaintiff $12.5 million against the hospital.
Was ectopic diagnosis wrong?
<court>Winnebago County (Ill) Circuit Court</court>
A 39-year-old woman with a history of pain from ovarian cysts experienced an acute increase in pain intensity, which persisted nearly a full day. Her physician diagnosed ectopic pregnancy and performed a laparoscopic salpingectomy.
The woman sued, claiming no ectopic pregnancy existed. Instead, she argued, her symptoms were due to an exacerbation of her cyst pain and salpingitis, as noted on pathology examination. She noted that her low levels of human chorionic gonadotropin made ectopic pregnancy unlikely.
She also alleged that endometriosis and adhesions caused by the procedure required additional surgery the following year.
The defendant maintained the woman’s symptoms were consistent with ectopic pregnancy and possible rupture, and thus the diagnosis and resultant surgery were appropriate.
- 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>Winnebago County (Ill) Circuit Court</court>
A 39-year-old woman with a history of pain from ovarian cysts experienced an acute increase in pain intensity, which persisted nearly a full day. Her physician diagnosed ectopic pregnancy and performed a laparoscopic salpingectomy.
The woman sued, claiming no ectopic pregnancy existed. Instead, she argued, her symptoms were due to an exacerbation of her cyst pain and salpingitis, as noted on pathology examination. She noted that her low levels of human chorionic gonadotropin made ectopic pregnancy unlikely.
She also alleged that endometriosis and adhesions caused by the procedure required additional surgery the following year.
The defendant maintained the woman’s symptoms were consistent with ectopic pregnancy and possible rupture, and thus the diagnosis and resultant surgery were appropriate.
- 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>Winnebago County (Ill) Circuit Court</court>
A 39-year-old woman with a history of pain from ovarian cysts experienced an acute increase in pain intensity, which persisted nearly a full day. Her physician diagnosed ectopic pregnancy and performed a laparoscopic salpingectomy.
The woman sued, claiming no ectopic pregnancy existed. Instead, she argued, her symptoms were due to an exacerbation of her cyst pain and salpingitis, as noted on pathology examination. She noted that her low levels of human chorionic gonadotropin made ectopic pregnancy unlikely.
She also alleged that endometriosis and adhesions caused by the procedure required additional surgery the following year.
The defendant maintained the woman’s symptoms were consistent with ectopic pregnancy and possible rupture, and thus the diagnosis and resultant surgery were appropriate.
- 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.
Woman dies after uterine atony
Following the delivery of her third child, a 37-year-old woman suffered uterine atony leading to intermittent bleeding. Over the next several hours, the patient:
- received bimanual compressions with fundal massage, oxytocin, methylergonovine, and carboprost;
- underwent an emergency dilatation and curettage, after tests revealed disseminated intravascular coagulation and her vital signs began deteriorating;
- received further fundal massage, misoprostol, packed red blood cells, normal saline, Ringer’s lactate, and hetastarch;
- underwent an emergency hysterectomy.
Though stable after surgery, the woman developed a cardiac arrhythmia and died due to a myocardial infarction.
In suing, plaintiffs claimed the defendant was negligent for his failure to consult a hematologist, follow up on lab results, and transfuse a sufficient amount of clotting factors before starting the hysterectomy.
The doctor claimed these actions would not have altered the outcome, noting that the woman’s blood volume was replaced nearly 7 times during the events.
- The jury returned a defense verdict
Following the delivery of her third child, a 37-year-old woman suffered uterine atony leading to intermittent bleeding. Over the next several hours, the patient:
- received bimanual compressions with fundal massage, oxytocin, methylergonovine, and carboprost;
- underwent an emergency dilatation and curettage, after tests revealed disseminated intravascular coagulation and her vital signs began deteriorating;
- received further fundal massage, misoprostol, packed red blood cells, normal saline, Ringer’s lactate, and hetastarch;
- underwent an emergency hysterectomy.
Though stable after surgery, the woman developed a cardiac arrhythmia and died due to a myocardial infarction.
In suing, plaintiffs claimed the defendant was negligent for his failure to consult a hematologist, follow up on lab results, and transfuse a sufficient amount of clotting factors before starting the hysterectomy.
The doctor claimed these actions would not have altered the outcome, noting that the woman’s blood volume was replaced nearly 7 times during the events.
- The jury returned a defense verdict
Following the delivery of her third child, a 37-year-old woman suffered uterine atony leading to intermittent bleeding. Over the next several hours, the patient:
- received bimanual compressions with fundal massage, oxytocin, methylergonovine, and carboprost;
- underwent an emergency dilatation and curettage, after tests revealed disseminated intravascular coagulation and her vital signs began deteriorating;
- received further fundal massage, misoprostol, packed red blood cells, normal saline, Ringer’s lactate, and hetastarch;
- underwent an emergency hysterectomy.
Though stable after surgery, the woman developed a cardiac arrhythmia and died due to a myocardial infarction.
In suing, plaintiffs claimed the defendant was negligent for his failure to consult a hematologist, follow up on lab results, and transfuse a sufficient amount of clotting factors before starting the hysterectomy.
The doctor claimed these actions would not have altered the outcome, noting that the woman’s blood volume was replaced nearly 7 times during the events.
- The jury returned a defense verdict
Did cesarean delay cause hypoxic injury?
After a nonstress test at her obstetrician’s office was nonreassuring, a gravida was sent to a nearby medical center, where an emergency cesarean was ordered. An ultrasound examination conducted at a different hospital 2 days prior was also nonreassuring, but no action was taken at that time.
Following the order to perform an emergency cesarean, 1 hour and 20 minutes passed before anesthesia was ready. The child, delivered 40 minutes later, suffered hypoxic injury leading to severe cerebral palsy. Age 17 at the time of trial, he has no use of his limbs and suffers severe mental retardation.
The plaintiffs sued the hospital that conducted the ultrasound, alleging negligence. They also sued the obstetrician and the medical center where the cesarean was performed, claiming delivery was unacceptably delayed. Had the child been delivered in a timely manner, they argued, his cerebral palsy could have been avoided.
The physician and medical center claimed the child’s injury occurred well before delivery, and an earlier cesarean would not have changed the outcome.
- The hospital performing the ultrasound settled prior to trial. The jury awarded plaintiffs $30 million against the obstetrician and delivering medical center.
After a nonstress test at her obstetrician’s office was nonreassuring, a gravida was sent to a nearby medical center, where an emergency cesarean was ordered. An ultrasound examination conducted at a different hospital 2 days prior was also nonreassuring, but no action was taken at that time.
Following the order to perform an emergency cesarean, 1 hour and 20 minutes passed before anesthesia was ready. The child, delivered 40 minutes later, suffered hypoxic injury leading to severe cerebral palsy. Age 17 at the time of trial, he has no use of his limbs and suffers severe mental retardation.
The plaintiffs sued the hospital that conducted the ultrasound, alleging negligence. They also sued the obstetrician and the medical center where the cesarean was performed, claiming delivery was unacceptably delayed. Had the child been delivered in a timely manner, they argued, his cerebral palsy could have been avoided.
The physician and medical center claimed the child’s injury occurred well before delivery, and an earlier cesarean would not have changed the outcome.
- The hospital performing the ultrasound settled prior to trial. The jury awarded plaintiffs $30 million against the obstetrician and delivering medical center.
After a nonstress test at her obstetrician’s office was nonreassuring, a gravida was sent to a nearby medical center, where an emergency cesarean was ordered. An ultrasound examination conducted at a different hospital 2 days prior was also nonreassuring, but no action was taken at that time.
Following the order to perform an emergency cesarean, 1 hour and 20 minutes passed before anesthesia was ready. The child, delivered 40 minutes later, suffered hypoxic injury leading to severe cerebral palsy. Age 17 at the time of trial, he has no use of his limbs and suffers severe mental retardation.
The plaintiffs sued the hospital that conducted the ultrasound, alleging negligence. They also sued the obstetrician and the medical center where the cesarean was performed, claiming delivery was unacceptably delayed. Had the child been delivered in a timely manner, they argued, his cerebral palsy could have been avoided.
The physician and medical center claimed the child’s injury occurred well before delivery, and an earlier cesarean would not have changed the outcome.
- The hospital performing the ultrasound settled prior to trial. The jury awarded plaintiffs $30 million against the obstetrician and delivering medical center.
Nephrectomy required after ureter injury
<court>Rockland County (NY) Supreme Court</court>
Two days after a bilateral oophorectomy for ovarian cysts, a 72-year-old woman developed spiking fevers. The pathologists, in examining a mass removed at surgery, discovered a segment of the ureter.
After unsuccessful surgery to reattach the ureter—during which swelling in the abdominal cavity prevented the physician from locating the ureter’s distal end—the woman went into septic shock and required several days of ventilation. She was placed on a nephrostomy bag, which she wore for the next 3 months, before undergoing a successful nephrectomy plus insertion of a Greenfield filter.
In suing, the woman claimed the surgeon failed to identify and protect her ureter during surgery, and further failed to recognize the injury in a timely fashion, when successful repair was still possible.
The defendant maintained he took all appropriate precautions.
- The jury awarded the plaintiff $2.6 million.
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>Rockland County (NY) Supreme Court</court>
Two days after a bilateral oophorectomy for ovarian cysts, a 72-year-old woman developed spiking fevers. The pathologists, in examining a mass removed at surgery, discovered a segment of the ureter.
After unsuccessful surgery to reattach the ureter—during which swelling in the abdominal cavity prevented the physician from locating the ureter’s distal end—the woman went into septic shock and required several days of ventilation. She was placed on a nephrostomy bag, which she wore for the next 3 months, before undergoing a successful nephrectomy plus insertion of a Greenfield filter.
In suing, the woman claimed the surgeon failed to identify and protect her ureter during surgery, and further failed to recognize the injury in a timely fashion, when successful repair was still possible.
The defendant maintained he took all appropriate precautions.
- The jury awarded the plaintiff $2.6 million.
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>Rockland County (NY) Supreme Court</court>
Two days after a bilateral oophorectomy for ovarian cysts, a 72-year-old woman developed spiking fevers. The pathologists, in examining a mass removed at surgery, discovered a segment of the ureter.
After unsuccessful surgery to reattach the ureter—during which swelling in the abdominal cavity prevented the physician from locating the ureter’s distal end—the woman went into septic shock and required several days of ventilation. She was placed on a nephrostomy bag, which she wore for the next 3 months, before undergoing a successful nephrectomy plus insertion of a Greenfield filter.
In suing, the woman claimed the surgeon failed to identify and protect her ureter during surgery, and further failed to recognize the injury in a timely fashion, when successful repair was still possible.
The defendant maintained he took all appropriate precautions.
- The jury awarded the plaintiff $2.6 million.
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.
4 CPT gems for 2005
The American College of Obstetricians and Gynecologists (ACOG) requested new codes to address the various techniques of vaginal vault suspension. Until this year, only 1 vaginal colpopexy code was available: sacrospinous ligament fixation. For any other type of suspension, we had to bill for the procedure using either the unlisted code 58999 or the code that was closest, 57282 (sacrospinous ligament fixation for prolapse of vagina).
As of January 1, the 2 code revisions, 57282 and 57283, will address any suspension technique (TABLE). Which you choose will depend on whether the suspension occurs outside the peritoneal cavity (by attaching it to the iliococcygeus muscle or sacrospinous ligament), or inside (using the uterosacral ligament or performing a high midline levator myorrhaphy).
Note that the code for the intraperitoneal approach cannot be billed with code 58263 (vaginal hysterectomy with bilateral salpingo-oophorectomy and enterocele repair).
Barbara S. Levy, MD
Medical Director, Women’s Health Center, Franciscan Health System, Federal Way, Wash. Dr. Levy is ACOG’s member on the AMA RBRVS Update Committee; ex-officio member, ACOG Committee on Coding and Nomenclature; and a member of the OBG Management Board of Editors.
The near-universal acceptance of the resource-based relative value scale (RBRVS) means that accurate and complete coding is essential for accurate and complete payment. Lack of appropriate codes for all of the gynecologic surgery procedures we perform has been an impediment to appropriate reimbursement.
This year in particular, the American College of Obstetricians and Gynecologists (ACOG) made important strides in helping us code for the procedures we perform.
- New codes for hysteroscopic sterilization and endometrial cryoablation signify recognition by the American Medical Association and Current Procedural Terminology (CPT) that these technologies represent major advances in women’s health. They allow us to supply services in the office setting with appropriate reimbursement to cover our costs.
- Pelvic floor reconstruction procedures have become more sophisticated, and it has been difficult to accurately describe our surgical approaches with existing codes. These codes have been revised, allowing us to distinguish between intraperitoneal and extraperitoneal suspension of the vaginal vault. In addition, a new code describes the use of graft material (any type) to augment anterior, posterior, or apical repairs.
- New Fetal Doppler codes, describing studies of the umbilical and middle cerebral arteries, allow us to code for the assessment of fetal anemia and fetal growth restriction.
Mesh augmentation
A new code was created for mesh augmentation, when the patient’s tissue is weak or inadequate for cystocele, rectocele, or enterocele repair. Code 57267 is an “add-on” code, meaning it is never used without an additional “base” code. It is billed with 45560 (rectocele repair), 57240 (anterior colporrhaphy), 57250 (posterior colporrhaphy), 57260 (combined anterior and posterior repair), or 57265 (combined anterior and posterior repair with enterocele repair).
Note that the code’s description indicates “each site.” Thus, if mesh is required in both the anterior and posterior compartments, code 57267 is listed twice.
2Cryoablation promoted from “developing technology”
Now rescued from Category III (temporary code 0009T), endometrial cryoablation has its own code, 58356, in the surgery section.
You should not bill separately for endometrial biopsy (58100), dilation and curettage (58120), saline-infusion sonogram/hysterosalpingogram (58340), abdominal ultrasound (76700), or pelvic ultrasound (76856); all are included in 58356. Note that the nomenclature states that ultrasound guidance is also included.
3Less hassle for less-invasive sterilization
Hysteroscopic sterilization (Essure; Conceptus, San Carlos, Calif)—which requires no abdominal incisions and can be performed in an office setting—now has its own code, 58565. Previously, the Healthcare Common Procedure Coding System (HCPCS) code S2555 and the code for an unlisted hysteroscopy (58579) were used to fill this coding gap. Physician practices will be happy to note that this code was given 57.77 relative value units (RVUs) when performed in a nonfacility setting—enough to cover the cost of the implants.
Do not report this with diagnostic hysteroscopy (58555) and/or dilation of cervix (57800). Since the code is valued as a bilateral procedure, add a modifier -52 (reduced services) if the device is placed unilaterally.
4More options for fetal Doppler
The addition of 2 codes for fetal Doppler of the umbilical and middle cerebral arteries (76820 and 76821) is most welcome for maternal-fetal medicine specialists evaluating fetal anemia and fetal growth restriction. Until now, these 2 scans were reported using the Doppler echocardiography codes 76827 (Doppler echocardiography, fetal, pulsed wave and/or continuous wave with spectral display; complete) or 76828 (Doppler echocardiography, … ; follow-up or repeat study).
Still no uterine artery Doppler code
For this, ACOG recommends continuing to use codes 76827 or 76828—but a closer code might be 93976 (Duplex scan of arterial inflow and venous outflow of abdominal, pelvic, scrotal contents and/or retroperitoneal organs; limited study).
Note the slight change in nomenclature for 76827. The phrase “cardiovascular system” was removed for CPT 2005.
ULTRASOUNDNew requirement: Images must be recorded
Most noteworthy of the new ultrasound guidelines is the requirement that an image be recorded. Permanently recorded images with measurements are required for all diagnostic ultrasound examinations (when such measurements are clinically indicated).
Ultrasound guidance procedures also require permanently recorded images of the site to be localized, and a documented description of the localization process, either separately or within the procedure report for which the guidance is utilized. A final, written report should be placed in the patient’s medical record.
For anatomic regions that have “complete” and “limited” ultrasound codes:
- Note the elements that comprise a “complete” exam, and include in the report a description of each or the reason an element could not be visualized.
- Use the “limited” code—once per patient exam session—if reporting less than the required elements for a complete exam (eg, limited number of organs or limited portion of region evaluated).
- Do not report a “limited” exam for the same exam session as a “complete” exam of that same region.
Use of ultrasound without thorough evaluation of organ(s) or anatomic region, image documentation, and final written report is not separately reportable.
Nonobstetric ultrasound
When to code complete ultrasound. The code for complete nonobstetric ultrasound (76856, Ultrasound, pelvic [nonobstetric], B-scan and/or real time with image documentation; complete) encompasses the comprehensive evaluation of the female pelvic anatomy, including:
- measurement of uterus and adnexal structures
- measurement of the endometrium
- measurement of the bladder (when applicable)
- description of any pelvic pathology
- focused examination limited to the assessment of 1 or more elements listed in code 76856, and/or
- reevaluation of 1 or more pelvic abnormalities previously seen on ultrasound.
ALSO NOTABLETotal omentectomy
Previously, no code existed to describe removal of the uterus and omentum for malignancy without lymph-node dissection. But when omental metastasis is present, pelvic and paraaortic lymph node dissection for staging is not usually necessary, since the disease has already spread into the abdominal cavity. New code 58956 addresses this problem. To report this code, the documentation must clearly indicate a total omentectomy (removal of both the lesser and greater omentum, also referred to as a supracolic omentectomy).
Debridement of genitalia
Three codes address debridement of the external genitalia and perineum skin for necrotizing soft tissue infection.
Screening for chromosome abnormalities
A new laboratory services code, 84163, describes the pregnancy-associated plasma protein-A (PAPP-A) screening test, used to identify women at highest risk of carrying a fetus with Down Syndrome, trisomy 18, or other chromosomal abnormality.
Oocyte storage
A revision to make “oocyte” plural in code 89346 (storage [per year]; oocytes) clarifies that each oocyte stored is not coded separately.
New appendices
Appendix F lists codes exempt from modifier -63 (Procedure performed on infants less than 4 kg).
Appendix G lists procedures that include conscious sedation. A new symbol, ••, was created to denote this for the individual codes included in this section. The only Ob/Gyn-specific code that carries this symbol is 58823 (drainage of pelvic abscess, transvaginal or transrectal approach, percutaneous [eg, ovarian, pericolic]).
Appendix H is an alphabetic index of Category II code performance measures (the index lists them by clinical condition or topic), and includes a brief description of the performance measure and its source.
Appendix I lists genetic testing code modifiers. Report these with the molecular lab procedures related to genetic testing. The modifiers are categorized by mutation: The first digit indicates the disease category, the second denotes the gene type. For instance, 0A signifies testing for the BRCA1 gene.
The American College of Obstetricians and Gynecologists (ACOG) requested new codes to address the various techniques of vaginal vault suspension. Until this year, only 1 vaginal colpopexy code was available: sacrospinous ligament fixation. For any other type of suspension, we had to bill for the procedure using either the unlisted code 58999 or the code that was closest, 57282 (sacrospinous ligament fixation for prolapse of vagina).
As of January 1, the 2 code revisions, 57282 and 57283, will address any suspension technique (TABLE). Which you choose will depend on whether the suspension occurs outside the peritoneal cavity (by attaching it to the iliococcygeus muscle or sacrospinous ligament), or inside (using the uterosacral ligament or performing a high midline levator myorrhaphy).
Note that the code for the intraperitoneal approach cannot be billed with code 58263 (vaginal hysterectomy with bilateral salpingo-oophorectomy and enterocele repair).
Barbara S. Levy, MD
Medical Director, Women’s Health Center, Franciscan Health System, Federal Way, Wash. Dr. Levy is ACOG’s member on the AMA RBRVS Update Committee; ex-officio member, ACOG Committee on Coding and Nomenclature; and a member of the OBG Management Board of Editors.
The near-universal acceptance of the resource-based relative value scale (RBRVS) means that accurate and complete coding is essential for accurate and complete payment. Lack of appropriate codes for all of the gynecologic surgery procedures we perform has been an impediment to appropriate reimbursement.
This year in particular, the American College of Obstetricians and Gynecologists (ACOG) made important strides in helping us code for the procedures we perform.
- New codes for hysteroscopic sterilization and endometrial cryoablation signify recognition by the American Medical Association and Current Procedural Terminology (CPT) that these technologies represent major advances in women’s health. They allow us to supply services in the office setting with appropriate reimbursement to cover our costs.
- Pelvic floor reconstruction procedures have become more sophisticated, and it has been difficult to accurately describe our surgical approaches with existing codes. These codes have been revised, allowing us to distinguish between intraperitoneal and extraperitoneal suspension of the vaginal vault. In addition, a new code describes the use of graft material (any type) to augment anterior, posterior, or apical repairs.
- New Fetal Doppler codes, describing studies of the umbilical and middle cerebral arteries, allow us to code for the assessment of fetal anemia and fetal growth restriction.
Mesh augmentation
A new code was created for mesh augmentation, when the patient’s tissue is weak or inadequate for cystocele, rectocele, or enterocele repair. Code 57267 is an “add-on” code, meaning it is never used without an additional “base” code. It is billed with 45560 (rectocele repair), 57240 (anterior colporrhaphy), 57250 (posterior colporrhaphy), 57260 (combined anterior and posterior repair), or 57265 (combined anterior and posterior repair with enterocele repair).
Note that the code’s description indicates “each site.” Thus, if mesh is required in both the anterior and posterior compartments, code 57267 is listed twice.
2Cryoablation promoted from “developing technology”
Now rescued from Category III (temporary code 0009T), endometrial cryoablation has its own code, 58356, in the surgery section.
You should not bill separately for endometrial biopsy (58100), dilation and curettage (58120), saline-infusion sonogram/hysterosalpingogram (58340), abdominal ultrasound (76700), or pelvic ultrasound (76856); all are included in 58356. Note that the nomenclature states that ultrasound guidance is also included.
3Less hassle for less-invasive sterilization
Hysteroscopic sterilization (Essure; Conceptus, San Carlos, Calif)—which requires no abdominal incisions and can be performed in an office setting—now has its own code, 58565. Previously, the Healthcare Common Procedure Coding System (HCPCS) code S2555 and the code for an unlisted hysteroscopy (58579) were used to fill this coding gap. Physician practices will be happy to note that this code was given 57.77 relative value units (RVUs) when performed in a nonfacility setting—enough to cover the cost of the implants.
Do not report this with diagnostic hysteroscopy (58555) and/or dilation of cervix (57800). Since the code is valued as a bilateral procedure, add a modifier -52 (reduced services) if the device is placed unilaterally.
4More options for fetal Doppler
The addition of 2 codes for fetal Doppler of the umbilical and middle cerebral arteries (76820 and 76821) is most welcome for maternal-fetal medicine specialists evaluating fetal anemia and fetal growth restriction. Until now, these 2 scans were reported using the Doppler echocardiography codes 76827 (Doppler echocardiography, fetal, pulsed wave and/or continuous wave with spectral display; complete) or 76828 (Doppler echocardiography, … ; follow-up or repeat study).
Still no uterine artery Doppler code
For this, ACOG recommends continuing to use codes 76827 or 76828—but a closer code might be 93976 (Duplex scan of arterial inflow and venous outflow of abdominal, pelvic, scrotal contents and/or retroperitoneal organs; limited study).
Note the slight change in nomenclature for 76827. The phrase “cardiovascular system” was removed for CPT 2005.
ULTRASOUNDNew requirement: Images must be recorded
Most noteworthy of the new ultrasound guidelines is the requirement that an image be recorded. Permanently recorded images with measurements are required for all diagnostic ultrasound examinations (when such measurements are clinically indicated).
Ultrasound guidance procedures also require permanently recorded images of the site to be localized, and a documented description of the localization process, either separately or within the procedure report for which the guidance is utilized. A final, written report should be placed in the patient’s medical record.
For anatomic regions that have “complete” and “limited” ultrasound codes:
- Note the elements that comprise a “complete” exam, and include in the report a description of each or the reason an element could not be visualized.
- Use the “limited” code—once per patient exam session—if reporting less than the required elements for a complete exam (eg, limited number of organs or limited portion of region evaluated).
- Do not report a “limited” exam for the same exam session as a “complete” exam of that same region.
Use of ultrasound without thorough evaluation of organ(s) or anatomic region, image documentation, and final written report is not separately reportable.
Nonobstetric ultrasound
When to code complete ultrasound. The code for complete nonobstetric ultrasound (76856, Ultrasound, pelvic [nonobstetric], B-scan and/or real time with image documentation; complete) encompasses the comprehensive evaluation of the female pelvic anatomy, including:
- measurement of uterus and adnexal structures
- measurement of the endometrium
- measurement of the bladder (when applicable)
- description of any pelvic pathology
- focused examination limited to the assessment of 1 or more elements listed in code 76856, and/or
- reevaluation of 1 or more pelvic abnormalities previously seen on ultrasound.
ALSO NOTABLETotal omentectomy
Previously, no code existed to describe removal of the uterus and omentum for malignancy without lymph-node dissection. But when omental metastasis is present, pelvic and paraaortic lymph node dissection for staging is not usually necessary, since the disease has already spread into the abdominal cavity. New code 58956 addresses this problem. To report this code, the documentation must clearly indicate a total omentectomy (removal of both the lesser and greater omentum, also referred to as a supracolic omentectomy).
Debridement of genitalia
Three codes address debridement of the external genitalia and perineum skin for necrotizing soft tissue infection.
Screening for chromosome abnormalities
A new laboratory services code, 84163, describes the pregnancy-associated plasma protein-A (PAPP-A) screening test, used to identify women at highest risk of carrying a fetus with Down Syndrome, trisomy 18, or other chromosomal abnormality.
Oocyte storage
A revision to make “oocyte” plural in code 89346 (storage [per year]; oocytes) clarifies that each oocyte stored is not coded separately.
New appendices
Appendix F lists codes exempt from modifier -63 (Procedure performed on infants less than 4 kg).
Appendix G lists procedures that include conscious sedation. A new symbol, ••, was created to denote this for the individual codes included in this section. The only Ob/Gyn-specific code that carries this symbol is 58823 (drainage of pelvic abscess, transvaginal or transrectal approach, percutaneous [eg, ovarian, pericolic]).
Appendix H is an alphabetic index of Category II code performance measures (the index lists them by clinical condition or topic), and includes a brief description of the performance measure and its source.
Appendix I lists genetic testing code modifiers. Report these with the molecular lab procedures related to genetic testing. The modifiers are categorized by mutation: The first digit indicates the disease category, the second denotes the gene type. For instance, 0A signifies testing for the BRCA1 gene.
The American College of Obstetricians and Gynecologists (ACOG) requested new codes to address the various techniques of vaginal vault suspension. Until this year, only 1 vaginal colpopexy code was available: sacrospinous ligament fixation. For any other type of suspension, we had to bill for the procedure using either the unlisted code 58999 or the code that was closest, 57282 (sacrospinous ligament fixation for prolapse of vagina).
As of January 1, the 2 code revisions, 57282 and 57283, will address any suspension technique (TABLE). Which you choose will depend on whether the suspension occurs outside the peritoneal cavity (by attaching it to the iliococcygeus muscle or sacrospinous ligament), or inside (using the uterosacral ligament or performing a high midline levator myorrhaphy).
Note that the code for the intraperitoneal approach cannot be billed with code 58263 (vaginal hysterectomy with bilateral salpingo-oophorectomy and enterocele repair).
Barbara S. Levy, MD
Medical Director, Women’s Health Center, Franciscan Health System, Federal Way, Wash. Dr. Levy is ACOG’s member on the AMA RBRVS Update Committee; ex-officio member, ACOG Committee on Coding and Nomenclature; and a member of the OBG Management Board of Editors.
The near-universal acceptance of the resource-based relative value scale (RBRVS) means that accurate and complete coding is essential for accurate and complete payment. Lack of appropriate codes for all of the gynecologic surgery procedures we perform has been an impediment to appropriate reimbursement.
This year in particular, the American College of Obstetricians and Gynecologists (ACOG) made important strides in helping us code for the procedures we perform.
- New codes for hysteroscopic sterilization and endometrial cryoablation signify recognition by the American Medical Association and Current Procedural Terminology (CPT) that these technologies represent major advances in women’s health. They allow us to supply services in the office setting with appropriate reimbursement to cover our costs.
- Pelvic floor reconstruction procedures have become more sophisticated, and it has been difficult to accurately describe our surgical approaches with existing codes. These codes have been revised, allowing us to distinguish between intraperitoneal and extraperitoneal suspension of the vaginal vault. In addition, a new code describes the use of graft material (any type) to augment anterior, posterior, or apical repairs.
- New Fetal Doppler codes, describing studies of the umbilical and middle cerebral arteries, allow us to code for the assessment of fetal anemia and fetal growth restriction.
Mesh augmentation
A new code was created for mesh augmentation, when the patient’s tissue is weak or inadequate for cystocele, rectocele, or enterocele repair. Code 57267 is an “add-on” code, meaning it is never used without an additional “base” code. It is billed with 45560 (rectocele repair), 57240 (anterior colporrhaphy), 57250 (posterior colporrhaphy), 57260 (combined anterior and posterior repair), or 57265 (combined anterior and posterior repair with enterocele repair).
Note that the code’s description indicates “each site.” Thus, if mesh is required in both the anterior and posterior compartments, code 57267 is listed twice.
2Cryoablation promoted from “developing technology”
Now rescued from Category III (temporary code 0009T), endometrial cryoablation has its own code, 58356, in the surgery section.
You should not bill separately for endometrial biopsy (58100), dilation and curettage (58120), saline-infusion sonogram/hysterosalpingogram (58340), abdominal ultrasound (76700), or pelvic ultrasound (76856); all are included in 58356. Note that the nomenclature states that ultrasound guidance is also included.
3Less hassle for less-invasive sterilization
Hysteroscopic sterilization (Essure; Conceptus, San Carlos, Calif)—which requires no abdominal incisions and can be performed in an office setting—now has its own code, 58565. Previously, the Healthcare Common Procedure Coding System (HCPCS) code S2555 and the code for an unlisted hysteroscopy (58579) were used to fill this coding gap. Physician practices will be happy to note that this code was given 57.77 relative value units (RVUs) when performed in a nonfacility setting—enough to cover the cost of the implants.
Do not report this with diagnostic hysteroscopy (58555) and/or dilation of cervix (57800). Since the code is valued as a bilateral procedure, add a modifier -52 (reduced services) if the device is placed unilaterally.
4More options for fetal Doppler
The addition of 2 codes for fetal Doppler of the umbilical and middle cerebral arteries (76820 and 76821) is most welcome for maternal-fetal medicine specialists evaluating fetal anemia and fetal growth restriction. Until now, these 2 scans were reported using the Doppler echocardiography codes 76827 (Doppler echocardiography, fetal, pulsed wave and/or continuous wave with spectral display; complete) or 76828 (Doppler echocardiography, … ; follow-up or repeat study).
Still no uterine artery Doppler code
For this, ACOG recommends continuing to use codes 76827 or 76828—but a closer code might be 93976 (Duplex scan of arterial inflow and venous outflow of abdominal, pelvic, scrotal contents and/or retroperitoneal organs; limited study).
Note the slight change in nomenclature for 76827. The phrase “cardiovascular system” was removed for CPT 2005.
ULTRASOUNDNew requirement: Images must be recorded
Most noteworthy of the new ultrasound guidelines is the requirement that an image be recorded. Permanently recorded images with measurements are required for all diagnostic ultrasound examinations (when such measurements are clinically indicated).
Ultrasound guidance procedures also require permanently recorded images of the site to be localized, and a documented description of the localization process, either separately or within the procedure report for which the guidance is utilized. A final, written report should be placed in the patient’s medical record.
For anatomic regions that have “complete” and “limited” ultrasound codes:
- Note the elements that comprise a “complete” exam, and include in the report a description of each or the reason an element could not be visualized.
- Use the “limited” code—once per patient exam session—if reporting less than the required elements for a complete exam (eg, limited number of organs or limited portion of region evaluated).
- Do not report a “limited” exam for the same exam session as a “complete” exam of that same region.
Use of ultrasound without thorough evaluation of organ(s) or anatomic region, image documentation, and final written report is not separately reportable.
Nonobstetric ultrasound
When to code complete ultrasound. The code for complete nonobstetric ultrasound (76856, Ultrasound, pelvic [nonobstetric], B-scan and/or real time with image documentation; complete) encompasses the comprehensive evaluation of the female pelvic anatomy, including:
- measurement of uterus and adnexal structures
- measurement of the endometrium
- measurement of the bladder (when applicable)
- description of any pelvic pathology
- focused examination limited to the assessment of 1 or more elements listed in code 76856, and/or
- reevaluation of 1 or more pelvic abnormalities previously seen on ultrasound.
ALSO NOTABLETotal omentectomy
Previously, no code existed to describe removal of the uterus and omentum for malignancy without lymph-node dissection. But when omental metastasis is present, pelvic and paraaortic lymph node dissection for staging is not usually necessary, since the disease has already spread into the abdominal cavity. New code 58956 addresses this problem. To report this code, the documentation must clearly indicate a total omentectomy (removal of both the lesser and greater omentum, also referred to as a supracolic omentectomy).
Debridement of genitalia
Three codes address debridement of the external genitalia and perineum skin for necrotizing soft tissue infection.
Screening for chromosome abnormalities
A new laboratory services code, 84163, describes the pregnancy-associated plasma protein-A (PAPP-A) screening test, used to identify women at highest risk of carrying a fetus with Down Syndrome, trisomy 18, or other chromosomal abnormality.
Oocyte storage
A revision to make “oocyte” plural in code 89346 (storage [per year]; oocytes) clarifies that each oocyte stored is not coded separately.
New appendices
Appendix F lists codes exempt from modifier -63 (Procedure performed on infants less than 4 kg).
Appendix G lists procedures that include conscious sedation. A new symbol, ••, was created to denote this for the individual codes included in this section. The only Ob/Gyn-specific code that carries this symbol is 58823 (drainage of pelvic abscess, transvaginal or transrectal approach, percutaneous [eg, ovarian, pericolic]).
Appendix H is an alphabetic index of Category II code performance measures (the index lists them by clinical condition or topic), and includes a brief description of the performance measure and its source.
Appendix I lists genetic testing code modifiers. Report these with the molecular lab procedures related to genetic testing. The modifiers are categorized by mutation: The first digit indicates the disease category, the second denotes the gene type. For instance, 0A signifies testing for the BRCA1 gene.
The Horizontal Filing Cabinet
Do you have stacks and stacks of “important” tasks piled on your desk? If so, you're far from alone. A majority of the physicians' desktops I've seen are littered with letters, folders, journals, charts, mail, books, and other paraphernalia, often several inches deep.
This is all important stuff, those doctors insist. And all of it has to be on top of the desk, in plain sight, so they won't forget to attend to it. I call such arrangements “horizontal file cabinets,” and here's my question: If all that stuff is so important, why has it been sitting there, untouched, for months?
Chances are, when you finally go through it, you'll find that most of it isn't that important at all. Or it may have been important at one time, but the deadline for completing it has long since passed. Or it may still be important, but it should be done as soon as possible. Like 3 weeks ago.
Horizontal filing cabinets are an esthetic and organizational nightmare. (“Don't worry,” I can hear you saying, “I know where everything is on my desk.” No, you don't.) And all those piles make completion of current projects that much more difficult by taking up all the usable desk space!
Transforming your horizontal filing cabinet into an efficient and useful desktop isn't that difficult, or even that time consuming. But you have to make yourself an appointment several hours long, and you have to make sure you keep the appointment. Make sure you will not be disturbed. Put the phones on service. You'll need a large wastebasket and a box of manila folders, and you'll need to free up space in a real file cabinet nearby. (I prefer lateral files because they are easier to build into office cabinetry and all of the contents are immediately visible when you open the drawer, but a vertical file will do.)
Now go through each and every piece of paper, book, magazine, pamphlet, and reminder note on your desk. As you look at each one, ask yourself which of the following three categories it belongs in:
▸ Is it trash?
▸ Is it delegatable?
▸ Is it a task you must do personally?
The first category will probably be the largest, and you know what to do with it. Notice that there is no category for “file and forget.” A full 80% of the “important” papers you file away for some vague future use will never be looked at again. Don't save anything just for the sake of saving it. Be merciless with each and every document. If it does not require action on someone's part, and if it contains information that is readily available elsewhere, throw it away!
Everything that can be delegated should be, immediately. Physicians often have a problem delegating—they're convinced no one can do any job as well as they can—but the fact is that any task that does not require a medical license is probably delegatable. Get it to the proper desk and leave it there, with any necessary instructions and a deadline. (Deadlines are excellent tools for focusing attention and encouraging prompt action.)
That leaves only the tasks you must do yourself. Resist the temptation to do them immediately. Instead, prepare a folder, properly labeled and with a deadline, for each one. File the folders, in order of deadlines, with the most urgent first, in your file cabinet.
Now you have a clean work surface. From now on, only one project—the most urgent one in the file drawer—should be on your desk at any given time. Everything else will be waiting its turn, out of sight, in your file cabinet.
Every new item that arrives on your desk should be placed in one of the same three categories: to do, to delegate, or to throw away.
Avoid the temptation to procrastinate by putting it over in the corner, “to do later.” Without an established priority or a deadline, it's not going to get done. And that, after all, is how you ended up with a horizontal filing cabinet in the first place.
Do you have stacks and stacks of “important” tasks piled on your desk? If so, you're far from alone. A majority of the physicians' desktops I've seen are littered with letters, folders, journals, charts, mail, books, and other paraphernalia, often several inches deep.
This is all important stuff, those doctors insist. And all of it has to be on top of the desk, in plain sight, so they won't forget to attend to it. I call such arrangements “horizontal file cabinets,” and here's my question: If all that stuff is so important, why has it been sitting there, untouched, for months?
Chances are, when you finally go through it, you'll find that most of it isn't that important at all. Or it may have been important at one time, but the deadline for completing it has long since passed. Or it may still be important, but it should be done as soon as possible. Like 3 weeks ago.
Horizontal filing cabinets are an esthetic and organizational nightmare. (“Don't worry,” I can hear you saying, “I know where everything is on my desk.” No, you don't.) And all those piles make completion of current projects that much more difficult by taking up all the usable desk space!
Transforming your horizontal filing cabinet into an efficient and useful desktop isn't that difficult, or even that time consuming. But you have to make yourself an appointment several hours long, and you have to make sure you keep the appointment. Make sure you will not be disturbed. Put the phones on service. You'll need a large wastebasket and a box of manila folders, and you'll need to free up space in a real file cabinet nearby. (I prefer lateral files because they are easier to build into office cabinetry and all of the contents are immediately visible when you open the drawer, but a vertical file will do.)
Now go through each and every piece of paper, book, magazine, pamphlet, and reminder note on your desk. As you look at each one, ask yourself which of the following three categories it belongs in:
▸ Is it trash?
▸ Is it delegatable?
▸ Is it a task you must do personally?
The first category will probably be the largest, and you know what to do with it. Notice that there is no category for “file and forget.” A full 80% of the “important” papers you file away for some vague future use will never be looked at again. Don't save anything just for the sake of saving it. Be merciless with each and every document. If it does not require action on someone's part, and if it contains information that is readily available elsewhere, throw it away!
Everything that can be delegated should be, immediately. Physicians often have a problem delegating—they're convinced no one can do any job as well as they can—but the fact is that any task that does not require a medical license is probably delegatable. Get it to the proper desk and leave it there, with any necessary instructions and a deadline. (Deadlines are excellent tools for focusing attention and encouraging prompt action.)
That leaves only the tasks you must do yourself. Resist the temptation to do them immediately. Instead, prepare a folder, properly labeled and with a deadline, for each one. File the folders, in order of deadlines, with the most urgent first, in your file cabinet.
Now you have a clean work surface. From now on, only one project—the most urgent one in the file drawer—should be on your desk at any given time. Everything else will be waiting its turn, out of sight, in your file cabinet.
Every new item that arrives on your desk should be placed in one of the same three categories: to do, to delegate, or to throw away.
Avoid the temptation to procrastinate by putting it over in the corner, “to do later.” Without an established priority or a deadline, it's not going to get done. And that, after all, is how you ended up with a horizontal filing cabinet in the first place.
Do you have stacks and stacks of “important” tasks piled on your desk? If so, you're far from alone. A majority of the physicians' desktops I've seen are littered with letters, folders, journals, charts, mail, books, and other paraphernalia, often several inches deep.
This is all important stuff, those doctors insist. And all of it has to be on top of the desk, in plain sight, so they won't forget to attend to it. I call such arrangements “horizontal file cabinets,” and here's my question: If all that stuff is so important, why has it been sitting there, untouched, for months?
Chances are, when you finally go through it, you'll find that most of it isn't that important at all. Or it may have been important at one time, but the deadline for completing it has long since passed. Or it may still be important, but it should be done as soon as possible. Like 3 weeks ago.
Horizontal filing cabinets are an esthetic and organizational nightmare. (“Don't worry,” I can hear you saying, “I know where everything is on my desk.” No, you don't.) And all those piles make completion of current projects that much more difficult by taking up all the usable desk space!
Transforming your horizontal filing cabinet into an efficient and useful desktop isn't that difficult, or even that time consuming. But you have to make yourself an appointment several hours long, and you have to make sure you keep the appointment. Make sure you will not be disturbed. Put the phones on service. You'll need a large wastebasket and a box of manila folders, and you'll need to free up space in a real file cabinet nearby. (I prefer lateral files because they are easier to build into office cabinetry and all of the contents are immediately visible when you open the drawer, but a vertical file will do.)
Now go through each and every piece of paper, book, magazine, pamphlet, and reminder note on your desk. As you look at each one, ask yourself which of the following three categories it belongs in:
▸ Is it trash?
▸ Is it delegatable?
▸ Is it a task you must do personally?
The first category will probably be the largest, and you know what to do with it. Notice that there is no category for “file and forget.” A full 80% of the “important” papers you file away for some vague future use will never be looked at again. Don't save anything just for the sake of saving it. Be merciless with each and every document. If it does not require action on someone's part, and if it contains information that is readily available elsewhere, throw it away!
Everything that can be delegated should be, immediately. Physicians often have a problem delegating—they're convinced no one can do any job as well as they can—but the fact is that any task that does not require a medical license is probably delegatable. Get it to the proper desk and leave it there, with any necessary instructions and a deadline. (Deadlines are excellent tools for focusing attention and encouraging prompt action.)
That leaves only the tasks you must do yourself. Resist the temptation to do them immediately. Instead, prepare a folder, properly labeled and with a deadline, for each one. File the folders, in order of deadlines, with the most urgent first, in your file cabinet.
Now you have a clean work surface. From now on, only one project—the most urgent one in the file drawer—should be on your desk at any given time. Everything else will be waiting its turn, out of sight, in your file cabinet.
Every new item that arrives on your desk should be placed in one of the same three categories: to do, to delegate, or to throw away.
Avoid the temptation to procrastinate by putting it over in the corner, “to do later.” Without an established priority or a deadline, it's not going to get done. And that, after all, is how you ended up with a horizontal filing cabinet in the first place.
Ectopic rupture death: Due to deficient care?
<court>Lucas County (Ohio) Court of Common Pleas</court>
A woman in her early 20s presented to her Ob/Gyn due to suspected pregnancy, which the physician confirmed. Six weeks later, the woman suffered a ruptured ectopic pregnancy and died due to blood loss.
The woman’s family claimed the doctor did not adequately counsel the patient on the risks of pregnancy, and failed to ensure she received proper follow-up care. They accused the defendant of altering the woman’s medical record.
The defendant maintained that the patient said she would seek an abortion, and denied tampering the woman’s records.
- 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>Lucas County (Ohio) Court of Common Pleas</court>
A woman in her early 20s presented to her Ob/Gyn due to suspected pregnancy, which the physician confirmed. Six weeks later, the woman suffered a ruptured ectopic pregnancy and died due to blood loss.
The woman’s family claimed the doctor did not adequately counsel the patient on the risks of pregnancy, and failed to ensure she received proper follow-up care. They accused the defendant of altering the woman’s medical record.
The defendant maintained that the patient said she would seek an abortion, and denied tampering the woman’s records.
- 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>Lucas County (Ohio) Court of Common Pleas</court>
A woman in her early 20s presented to her Ob/Gyn due to suspected pregnancy, which the physician confirmed. Six weeks later, the woman suffered a ruptured ectopic pregnancy and died due to blood loss.
The woman’s family claimed the doctor did not adequately counsel the patient on the risks of pregnancy, and failed to ensure she received proper follow-up care. They accused the defendant of altering the woman’s medical record.
The defendant maintained that the patient said she would seek an abortion, and denied tampering the woman’s records.
- 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.
Trichloroacetic acid used at colposcopy
During a colposcopy, a 24-year-old woman experienced a severely painful burning sensation, prompting the physician to halt the procedure. Investigation revealed the medical assistant had handed the physician trichloroacetic acid rather than acetic acid with which to swab the cervix.
This error, according to the plaintiff, led to vaginal burns, permanent injury to nerves inside the vaginal wall, and chronic painful spasms during intercourse.
The patient sued the gynecologist, citing negligence in not checking the bottle of solution prior to application; the medical assistant, for supplying the doctor with the wrong chemical; and the health plan that employed the assistant.
The physician argued it was the medical assistant’s responsibility to have proper materials ready for the procedure.
The assistant claimed that infection and other problems present prior to the colposcopy—not the trichloroacetic acid—caused the patients’ injuries.
- The jury returned a defense verdict for the obstetrician, and awarded the plaintiff $500,000 against the medical assistant and the health plan.
During a colposcopy, a 24-year-old woman experienced a severely painful burning sensation, prompting the physician to halt the procedure. Investigation revealed the medical assistant had handed the physician trichloroacetic acid rather than acetic acid with which to swab the cervix.
This error, according to the plaintiff, led to vaginal burns, permanent injury to nerves inside the vaginal wall, and chronic painful spasms during intercourse.
The patient sued the gynecologist, citing negligence in not checking the bottle of solution prior to application; the medical assistant, for supplying the doctor with the wrong chemical; and the health plan that employed the assistant.
The physician argued it was the medical assistant’s responsibility to have proper materials ready for the procedure.
The assistant claimed that infection and other problems present prior to the colposcopy—not the trichloroacetic acid—caused the patients’ injuries.
- The jury returned a defense verdict for the obstetrician, and awarded the plaintiff $500,000 against the medical assistant and the health plan.
During a colposcopy, a 24-year-old woman experienced a severely painful burning sensation, prompting the physician to halt the procedure. Investigation revealed the medical assistant had handed the physician trichloroacetic acid rather than acetic acid with which to swab the cervix.
This error, according to the plaintiff, led to vaginal burns, permanent injury to nerves inside the vaginal wall, and chronic painful spasms during intercourse.
The patient sued the gynecologist, citing negligence in not checking the bottle of solution prior to application; the medical assistant, for supplying the doctor with the wrong chemical; and the health plan that employed the assistant.
The physician argued it was the medical assistant’s responsibility to have proper materials ready for the procedure.
The assistant claimed that infection and other problems present prior to the colposcopy—not the trichloroacetic acid—caused the patients’ injuries.
- The jury returned a defense verdict for the obstetrician, and awarded the plaintiff $500,000 against the medical assistant and the health plan.