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Ovarian detorsion: Limited coding options
Two coding scenarios have been suggested: The first is 58925 (Ovarian cystectomy, unilateral or bilateral) 58825 (Transposition, ovary[s]), and 49320 (Laparoscopy, abdomen, peritoneum, and omentum, diagnostic, with or without collection of specimen[s] by brushing or washing). I hesitate to use these, though, since an ovarian cystectomy was not performed and the tube and ovary were detorsed, not transposed elsewhere.
The second option is 49000 (Exploratory laparotomy, exploratory celiotomy with or without biopsy[s]) with modifier -22 (unusual procedural services), plus 49320.Are these appropriate?
The exploratory laparotomy is not separately bil lable, since you’ll be billing for open surgical procedures. When this happens, the exploratory becomes integral to the surgical technique.
Next is detorsion of the left ovary: CPT does not have a code for this.
You then bivalved the ovary, which is analogous to performing a wedge resection, code 58920 (Wedge resection or bisection of ovary, unilateral or bilateral).
Finally, for the oophoropexy, you are correct that code 58825 is not applicable. If you had moved the ovary out of harm’s way due to radiation treatment, the procedure is referred to as transposition of the ovary and 58825 is reported. In this case, however, I’m guessing you sutured the ovary in place so it can no longer twist. Like the detorsion, CPT has no code for this.
Your coding options are limited, but I would suggest 58920-22—which covers the bivalving, detorsion, and oophoropexy—plus 49320-59 for the diagnostic laparoscopy. (The “distinct procedure” modifier indicates that the laparoscopy was not integral to the rest of the procedure.)
As far as diagnosis, the code linked to 58920 is 620.5 (Torsion of ovary, ovarian pedicle, or fallopian tube), or 752.0 (Congenital anomalies of ovaries) if you know the problem is congenital. Consider a different diagnosis for the laparoscopy, such as lower quadrant abdominal pain (789.03 or 789.04) or ovarian pain (625.9). Finally, add V64.41 to indicate the conversion from laparoscopy to an open procedure.
Two coding scenarios have been suggested: The first is 58925 (Ovarian cystectomy, unilateral or bilateral) 58825 (Transposition, ovary[s]), and 49320 (Laparoscopy, abdomen, peritoneum, and omentum, diagnostic, with or without collection of specimen[s] by brushing or washing). I hesitate to use these, though, since an ovarian cystectomy was not performed and the tube and ovary were detorsed, not transposed elsewhere.
The second option is 49000 (Exploratory laparotomy, exploratory celiotomy with or without biopsy[s]) with modifier -22 (unusual procedural services), plus 49320.Are these appropriate?
The exploratory laparotomy is not separately bil lable, since you’ll be billing for open surgical procedures. When this happens, the exploratory becomes integral to the surgical technique.
Next is detorsion of the left ovary: CPT does not have a code for this.
You then bivalved the ovary, which is analogous to performing a wedge resection, code 58920 (Wedge resection or bisection of ovary, unilateral or bilateral).
Finally, for the oophoropexy, you are correct that code 58825 is not applicable. If you had moved the ovary out of harm’s way due to radiation treatment, the procedure is referred to as transposition of the ovary and 58825 is reported. In this case, however, I’m guessing you sutured the ovary in place so it can no longer twist. Like the detorsion, CPT has no code for this.
Your coding options are limited, but I would suggest 58920-22—which covers the bivalving, detorsion, and oophoropexy—plus 49320-59 for the diagnostic laparoscopy. (The “distinct procedure” modifier indicates that the laparoscopy was not integral to the rest of the procedure.)
As far as diagnosis, the code linked to 58920 is 620.5 (Torsion of ovary, ovarian pedicle, or fallopian tube), or 752.0 (Congenital anomalies of ovaries) if you know the problem is congenital. Consider a different diagnosis for the laparoscopy, such as lower quadrant abdominal pain (789.03 or 789.04) or ovarian pain (625.9). Finally, add V64.41 to indicate the conversion from laparoscopy to an open procedure.
Two coding scenarios have been suggested: The first is 58925 (Ovarian cystectomy, unilateral or bilateral) 58825 (Transposition, ovary[s]), and 49320 (Laparoscopy, abdomen, peritoneum, and omentum, diagnostic, with or without collection of specimen[s] by brushing or washing). I hesitate to use these, though, since an ovarian cystectomy was not performed and the tube and ovary were detorsed, not transposed elsewhere.
The second option is 49000 (Exploratory laparotomy, exploratory celiotomy with or without biopsy[s]) with modifier -22 (unusual procedural services), plus 49320.Are these appropriate?
The exploratory laparotomy is not separately bil lable, since you’ll be billing for open surgical procedures. When this happens, the exploratory becomes integral to the surgical technique.
Next is detorsion of the left ovary: CPT does not have a code for this.
You then bivalved the ovary, which is analogous to performing a wedge resection, code 58920 (Wedge resection or bisection of ovary, unilateral or bilateral).
Finally, for the oophoropexy, you are correct that code 58825 is not applicable. If you had moved the ovary out of harm’s way due to radiation treatment, the procedure is referred to as transposition of the ovary and 58825 is reported. In this case, however, I’m guessing you sutured the ovary in place so it can no longer twist. Like the detorsion, CPT has no code for this.
Your coding options are limited, but I would suggest 58920-22—which covers the bivalving, detorsion, and oophoropexy—plus 49320-59 for the diagnostic laparoscopy. (The “distinct procedure” modifier indicates that the laparoscopy was not integral to the rest of the procedure.)
As far as diagnosis, the code linked to 58920 is 620.5 (Torsion of ovary, ovarian pedicle, or fallopian tube), or 752.0 (Congenital anomalies of ovaries) if you know the problem is congenital. Consider a different diagnosis for the laparoscopy, such as lower quadrant abdominal pain (789.03 or 789.04) or ovarian pain (625.9). Finally, add V64.41 to indicate the conversion from laparoscopy to an open procedure.
Both ER and Ob deliver: Who gets paid?
Labor and delivery staff had by then arrived. They took neonate and mom to the Ob suite, where I delivered the placenta and inspected and attended to the vagina.
The ER coded that their physician performed the “delivery,” using 59409 (Vaginal delivery only [with or without episiotomy and/or forceps]). They felt they would be out of compliance if they did not bill as such. I disagree. They took a large part of the Ob fee, and we were denied the payment for our complete obstetric care.
What should they have coded?
In this case, the ER physician may bill for delivery, but should have included modifier –52 to indicate a reduced service Code 59409 includes the delivery of the placenta (and episiotomy, if required), which the ER physician did not perform.
For your part, you have 2 coding options: You can bill for the global care, but add modifier -52 to 59400 (Routine obstetric care including antepartum care, vaginal delivery [with or without episiotomy, and/or forceps]). You’ll need to submit documentation indicating what part of the global care you did not perform. Here I would emphasize that the ER physician did not do labor management, delivery of the placenta, episiotomy, or any follow-up care—and that as such, the total amount for the delivery should not be deducted from your global fee.
Conversely, you can itemize the services you performed. This could consist of the following codes:
- 59426: seven or more antepartum visits (your fee will be the total for all visits)
- 9922X: hospital admission
- 59300: episiotomy repair (this code has 0 global days)
- 59414-51: delivery of placenta (again, 0 global days)
- 9923X: subsequent hospital care
- 99238: hospital discharge (if applicable)
- 59430: postpartum care (outpatient)
Labor and delivery staff had by then arrived. They took neonate and mom to the Ob suite, where I delivered the placenta and inspected and attended to the vagina.
The ER coded that their physician performed the “delivery,” using 59409 (Vaginal delivery only [with or without episiotomy and/or forceps]). They felt they would be out of compliance if they did not bill as such. I disagree. They took a large part of the Ob fee, and we were denied the payment for our complete obstetric care.
What should they have coded?
In this case, the ER physician may bill for delivery, but should have included modifier –52 to indicate a reduced service Code 59409 includes the delivery of the placenta (and episiotomy, if required), which the ER physician did not perform.
For your part, you have 2 coding options: You can bill for the global care, but add modifier -52 to 59400 (Routine obstetric care including antepartum care, vaginal delivery [with or without episiotomy, and/or forceps]). You’ll need to submit documentation indicating what part of the global care you did not perform. Here I would emphasize that the ER physician did not do labor management, delivery of the placenta, episiotomy, or any follow-up care—and that as such, the total amount for the delivery should not be deducted from your global fee.
Conversely, you can itemize the services you performed. This could consist of the following codes:
- 59426: seven or more antepartum visits (your fee will be the total for all visits)
- 9922X: hospital admission
- 59300: episiotomy repair (this code has 0 global days)
- 59414-51: delivery of placenta (again, 0 global days)
- 9923X: subsequent hospital care
- 99238: hospital discharge (if applicable)
- 59430: postpartum care (outpatient)
Labor and delivery staff had by then arrived. They took neonate and mom to the Ob suite, where I delivered the placenta and inspected and attended to the vagina.
The ER coded that their physician performed the “delivery,” using 59409 (Vaginal delivery only [with or without episiotomy and/or forceps]). They felt they would be out of compliance if they did not bill as such. I disagree. They took a large part of the Ob fee, and we were denied the payment for our complete obstetric care.
What should they have coded?
In this case, the ER physician may bill for delivery, but should have included modifier –52 to indicate a reduced service Code 59409 includes the delivery of the placenta (and episiotomy, if required), which the ER physician did not perform.
For your part, you have 2 coding options: You can bill for the global care, but add modifier -52 to 59400 (Routine obstetric care including antepartum care, vaginal delivery [with or without episiotomy, and/or forceps]). You’ll need to submit documentation indicating what part of the global care you did not perform. Here I would emphasize that the ER physician did not do labor management, delivery of the placenta, episiotomy, or any follow-up care—and that as such, the total amount for the delivery should not be deducted from your global fee.
Conversely, you can itemize the services you performed. This could consist of the following codes:
- 59426: seven or more antepartum visits (your fee will be the total for all visits)
- 9922X: hospital admission
- 59300: episiotomy repair (this code has 0 global days)
- 59414-51: delivery of placenta (again, 0 global days)
- 9923X: subsequent hospital care
- 99238: hospital discharge (if applicable)
- 59430: postpartum care (outpatient)
E/M visit before Ob care: What’s OK?
My question is, what other services can I provide at this E/M visit? Can I order prenatal labs? Gyn probe? Prenatal vitamins? I don’t want to cross the line.
As to what else is allowed: You can perform any service that is not normally part of the Ob global package (meaning it can be billed separately).
Prescribing vitamins and ordering labs is permissible, since these are minor activities that do not impact the level of E/M service you bill.
The Gyn probe is questionable, since it is not done unless the patient is pregnant. However, since this is generally a separately billable service, the payer may allow it.
Just be sure you’re not counseling for the pregnancy or taking pregnancy measurements, and then coding a higher level of E/M service. Any payer will likely construe this as initiation of global care.
My question is, what other services can I provide at this E/M visit? Can I order prenatal labs? Gyn probe? Prenatal vitamins? I don’t want to cross the line.
As to what else is allowed: You can perform any service that is not normally part of the Ob global package (meaning it can be billed separately).
Prescribing vitamins and ordering labs is permissible, since these are minor activities that do not impact the level of E/M service you bill.
The Gyn probe is questionable, since it is not done unless the patient is pregnant. However, since this is generally a separately billable service, the payer may allow it.
Just be sure you’re not counseling for the pregnancy or taking pregnancy measurements, and then coding a higher level of E/M service. Any payer will likely construe this as initiation of global care.
My question is, what other services can I provide at this E/M visit? Can I order prenatal labs? Gyn probe? Prenatal vitamins? I don’t want to cross the line.
As to what else is allowed: You can perform any service that is not normally part of the Ob global package (meaning it can be billed separately).
Prescribing vitamins and ordering labs is permissible, since these are minor activities that do not impact the level of E/M service you bill.
The Gyn probe is questionable, since it is not done unless the patient is pregnant. However, since this is generally a separately billable service, the payer may allow it.
Just be sure you’re not counseling for the pregnancy or taking pregnancy measurements, and then coding a higher level of E/M service. Any payer will likely construe this as initiation of global care.
Placing an ON-Q: Incidental to surgery?
The only work required for this system is placing the tube into the incision site before closing. The company recommends using code 58999 (Unlisted procedure, female genital system [non-obstetrical], for placement of needles and catheters) for non-Ob procedures and 59899 (Unlisted procedure, maternity care and delivery) for obstetric surgery.
Reimbursement will depend on the payer’s policy regarding placing catheters during surgery: Many hold the opinion that this is incidental to the procedure. However, I’m told that on appeal Aetna, Avmed, and Cigna HMO have reimbursed for placing the catheter, but United and Blue Cross/Blue Shield have not.
You can also bill for the system itself if you—not the hospital—supplied it to the patient.
The only work required for this system is placing the tube into the incision site before closing. The company recommends using code 58999 (Unlisted procedure, female genital system [non-obstetrical], for placement of needles and catheters) for non-Ob procedures and 59899 (Unlisted procedure, maternity care and delivery) for obstetric surgery.
Reimbursement will depend on the payer’s policy regarding placing catheters during surgery: Many hold the opinion that this is incidental to the procedure. However, I’m told that on appeal Aetna, Avmed, and Cigna HMO have reimbursed for placing the catheter, but United and Blue Cross/Blue Shield have not.
You can also bill for the system itself if you—not the hospital—supplied it to the patient.
The only work required for this system is placing the tube into the incision site before closing. The company recommends using code 58999 (Unlisted procedure, female genital system [non-obstetrical], for placement of needles and catheters) for non-Ob procedures and 59899 (Unlisted procedure, maternity care and delivery) for obstetric surgery.
Reimbursement will depend on the payer’s policy regarding placing catheters during surgery: Many hold the opinion that this is incidental to the procedure. However, I’m told that on appeal Aetna, Avmed, and Cigna HMO have reimbursed for placing the catheter, but United and Blue Cross/Blue Shield have not.
You can also bill for the system itself if you—not the hospital—supplied it to the patient.
Tracking down the correct Medicare LMPR
<huc>Q</huc> I’m trying to find out if Medicare will reimburse for intralesional injections into genital warts (CPT code 11900: Injection, skin intralesional, 1-7 lesions) with interferon alpha-n3.
When I looked this up under the heading “office injectable,” the Medicare carrier policy stated that a diagnosis of genital warts (078.10, Viral warts, unspecified; or 078.19, Viral warts, other specified) was allowed only when billed with intralesional administration of bleomycin.
Is this correct?
<huc>A</huc> This brings up an interesting question: How easy is it to zero in on the correct Medicare local medical policy review (LMPR)?
I’ve found I usually have to search their policy database (www.cms.hhs.gov/mcd/search.asp?) trying several different terms to get the results I need. I usually start with a term that is broad but specific, and then move to terms that are very specific.
Searching for code 11900 would produce too many hits; simply using the phrase “office injectable” is also not specific enough, since it implies intramuscular injections or supplied drugs. In this case, I started with “intralesional injection” and came up with 2 LMPRs. When I entered “interferon alfa-n3” I got 1 hit for Regence Blue Cross/Blue Shield, which indicates the injection is covered.
Following are the policies of 2 Medicare carriers (my notes appear in brackets). Based on these results, it looks like the injection should be covered:
- AdminaStar Federal policy. Intralesional injection of interferon alfa-n3 [coded using J9215] has been associated with complete or partial resolution of lesions associated with infection by HPV. It is currently indicated for the local treatment of Condylomata acuminate [coded as 078.11]. Coverage will be provided for those applications in which clinical utility has been demonstrated.
- Cahaba policy. Recombinant interferon alfa-2b, interferon alfa-n1 (1ns), and interferon alfa-n3 are indicated by intralesional injection for treatment of refractory or recurrent external condyloma acuminatum (genital warts).
<huc>Q</huc> I’m trying to find out if Medicare will reimburse for intralesional injections into genital warts (CPT code 11900: Injection, skin intralesional, 1-7 lesions) with interferon alpha-n3.
When I looked this up under the heading “office injectable,” the Medicare carrier policy stated that a diagnosis of genital warts (078.10, Viral warts, unspecified; or 078.19, Viral warts, other specified) was allowed only when billed with intralesional administration of bleomycin.
Is this correct?
<huc>A</huc> This brings up an interesting question: How easy is it to zero in on the correct Medicare local medical policy review (LMPR)?
I’ve found I usually have to search their policy database (www.cms.hhs.gov/mcd/search.asp?) trying several different terms to get the results I need. I usually start with a term that is broad but specific, and then move to terms that are very specific.
Searching for code 11900 would produce too many hits; simply using the phrase “office injectable” is also not specific enough, since it implies intramuscular injections or supplied drugs. In this case, I started with “intralesional injection” and came up with 2 LMPRs. When I entered “interferon alfa-n3” I got 1 hit for Regence Blue Cross/Blue Shield, which indicates the injection is covered.
Following are the policies of 2 Medicare carriers (my notes appear in brackets). Based on these results, it looks like the injection should be covered:
- AdminaStar Federal policy. Intralesional injection of interferon alfa-n3 [coded using J9215] has been associated with complete or partial resolution of lesions associated with infection by HPV. It is currently indicated for the local treatment of Condylomata acuminate [coded as 078.11]. Coverage will be provided for those applications in which clinical utility has been demonstrated.
- Cahaba policy. Recombinant interferon alfa-2b, interferon alfa-n1 (1ns), and interferon alfa-n3 are indicated by intralesional injection for treatment of refractory or recurrent external condyloma acuminatum (genital warts).
<huc>Q</huc> I’m trying to find out if Medicare will reimburse for intralesional injections into genital warts (CPT code 11900: Injection, skin intralesional, 1-7 lesions) with interferon alpha-n3.
When I looked this up under the heading “office injectable,” the Medicare carrier policy stated that a diagnosis of genital warts (078.10, Viral warts, unspecified; or 078.19, Viral warts, other specified) was allowed only when billed with intralesional administration of bleomycin.
Is this correct?
<huc>A</huc> This brings up an interesting question: How easy is it to zero in on the correct Medicare local medical policy review (LMPR)?
I’ve found I usually have to search their policy database (www.cms.hhs.gov/mcd/search.asp?) trying several different terms to get the results I need. I usually start with a term that is broad but specific, and then move to terms that are very specific.
Searching for code 11900 would produce too many hits; simply using the phrase “office injectable” is also not specific enough, since it implies intramuscular injections or supplied drugs. In this case, I started with “intralesional injection” and came up with 2 LMPRs. When I entered “interferon alfa-n3” I got 1 hit for Regence Blue Cross/Blue Shield, which indicates the injection is covered.
Following are the policies of 2 Medicare carriers (my notes appear in brackets). Based on these results, it looks like the injection should be covered:
- AdminaStar Federal policy. Intralesional injection of interferon alfa-n3 [coded using J9215] has been associated with complete or partial resolution of lesions associated with infection by HPV. It is currently indicated for the local treatment of Condylomata acuminate [coded as 078.11]. Coverage will be provided for those applications in which clinical utility has been demonstrated.
- Cahaba policy. Recombinant interferon alfa-2b, interferon alfa-n1 (1ns), and interferon alfa-n3 are indicated by intralesional injection for treatment of refractory or recurrent external condyloma acuminatum (genital warts).
Mother dies following cesarean for fetal demise
Complaining of decreased fetal movement and cramping, a 36-year-old gravida with a prior cesarean presented to a hospital with a fever. A sonogram revealed fetal demise. Labor induction was scheduled for 5 days later, and the patient was sent home.
Two days later, the woman returned to the hospital with pain and bleeding, but was sent home and instructed to return for the scheduled induction. That same night, however, she once again presented, demanding the fetus be delivered. Blood tests revealed a white blood cell count of 9,900 with 88.7% neutrophils.
The physician attempted to deliver the child vaginally, but the mother insisted on a cesarean section. When the fetus was delivered by cesarean the following morning, placenta previa and placenta accreta were discovered.
Postoperatively, the woman suffered heavy vaginal bleeding. Despite the administration of packed red blood cells, she was later found in septic shock. She died that night. Autopsy revealed placental remains in the uterus.
In suing, the woman’s family alleged that the physician was negligent in not initiating cesarean delivery sooner. Had the fetus been delivered 2 days earlier, they claimed, the mother would have survived.
The defendant physician argued that the patient died not of sepsis, but of bleeding due to the placenta accreta—a condition the doctor was powerless to treat. She maintained that the scheduled delivery date was appropriate given the woman’s symptoms.
- The jury awarded the plaintiff $4 million
Complaining of decreased fetal movement and cramping, a 36-year-old gravida with a prior cesarean presented to a hospital with a fever. A sonogram revealed fetal demise. Labor induction was scheduled for 5 days later, and the patient was sent home.
Two days later, the woman returned to the hospital with pain and bleeding, but was sent home and instructed to return for the scheduled induction. That same night, however, she once again presented, demanding the fetus be delivered. Blood tests revealed a white blood cell count of 9,900 with 88.7% neutrophils.
The physician attempted to deliver the child vaginally, but the mother insisted on a cesarean section. When the fetus was delivered by cesarean the following morning, placenta previa and placenta accreta were discovered.
Postoperatively, the woman suffered heavy vaginal bleeding. Despite the administration of packed red blood cells, she was later found in septic shock. She died that night. Autopsy revealed placental remains in the uterus.
In suing, the woman’s family alleged that the physician was negligent in not initiating cesarean delivery sooner. Had the fetus been delivered 2 days earlier, they claimed, the mother would have survived.
The defendant physician argued that the patient died not of sepsis, but of bleeding due to the placenta accreta—a condition the doctor was powerless to treat. She maintained that the scheduled delivery date was appropriate given the woman’s symptoms.
- The jury awarded the plaintiff $4 million
Complaining of decreased fetal movement and cramping, a 36-year-old gravida with a prior cesarean presented to a hospital with a fever. A sonogram revealed fetal demise. Labor induction was scheduled for 5 days later, and the patient was sent home.
Two days later, the woman returned to the hospital with pain and bleeding, but was sent home and instructed to return for the scheduled induction. That same night, however, she once again presented, demanding the fetus be delivered. Blood tests revealed a white blood cell count of 9,900 with 88.7% neutrophils.
The physician attempted to deliver the child vaginally, but the mother insisted on a cesarean section. When the fetus was delivered by cesarean the following morning, placenta previa and placenta accreta were discovered.
Postoperatively, the woman suffered heavy vaginal bleeding. Despite the administration of packed red blood cells, she was later found in septic shock. She died that night. Autopsy revealed placental remains in the uterus.
In suing, the woman’s family alleged that the physician was negligent in not initiating cesarean delivery sooner. Had the fetus been delivered 2 days earlier, they claimed, the mother would have survived.
The defendant physician argued that the patient died not of sepsis, but of bleeding due to the placenta accreta—a condition the doctor was powerless to treat. She maintained that the scheduled delivery date was appropriate given the woman’s symptoms.
- The jury awarded the plaintiff $4 million
Silver-Russell dwarfism follows undetected pregnancy
A 44-year-old woman with a deformed uterus (due to diethylstilbestrol exposure in utero) presented to a medical center for hormone replacement therapy. At that time she was told pregnancy was impossible, and that she did not need contraceptives.
During a scheduled exam, symptoms typical of pregnancy were noted, but attributed to menopause. The nurse practitioner conducting the pelvic exam did not palpate the woman’s enlarged uterus.
Approximately a month and a half later, a computed tomography scan was performed to rule out an abdominal tumor. At that time it was discovered that the patient was 6 and a half months pregnant.
The woman delivered a baby girl with Silver-Russell dwarfism, which will require a multiple surgeries, hormone treatments, and physical therapy.
The patient claimed the defendants were negligent in failing to diagnose her pregnancy in a timely manner, eliminating her option to terminate the pregnancy if desired. Further, she maintained that the child’s condition stemmed from prenatal exposure to hormone replacement therapy, computed tomography, and prescription drugs.
The defendants denied the patients claims.
- The case settled for $1.7 million.
A 44-year-old woman with a deformed uterus (due to diethylstilbestrol exposure in utero) presented to a medical center for hormone replacement therapy. At that time she was told pregnancy was impossible, and that she did not need contraceptives.
During a scheduled exam, symptoms typical of pregnancy were noted, but attributed to menopause. The nurse practitioner conducting the pelvic exam did not palpate the woman’s enlarged uterus.
Approximately a month and a half later, a computed tomography scan was performed to rule out an abdominal tumor. At that time it was discovered that the patient was 6 and a half months pregnant.
The woman delivered a baby girl with Silver-Russell dwarfism, which will require a multiple surgeries, hormone treatments, and physical therapy.
The patient claimed the defendants were negligent in failing to diagnose her pregnancy in a timely manner, eliminating her option to terminate the pregnancy if desired. Further, she maintained that the child’s condition stemmed from prenatal exposure to hormone replacement therapy, computed tomography, and prescription drugs.
The defendants denied the patients claims.
- The case settled for $1.7 million.
A 44-year-old woman with a deformed uterus (due to diethylstilbestrol exposure in utero) presented to a medical center for hormone replacement therapy. At that time she was told pregnancy was impossible, and that she did not need contraceptives.
During a scheduled exam, symptoms typical of pregnancy were noted, but attributed to menopause. The nurse practitioner conducting the pelvic exam did not palpate the woman’s enlarged uterus.
Approximately a month and a half later, a computed tomography scan was performed to rule out an abdominal tumor. At that time it was discovered that the patient was 6 and a half months pregnant.
The woman delivered a baby girl with Silver-Russell dwarfism, which will require a multiple surgeries, hormone treatments, and physical therapy.
The patient claimed the defendants were negligent in failing to diagnose her pregnancy in a timely manner, eliminating her option to terminate the pregnancy if desired. Further, she maintained that the child’s condition stemmed from prenatal exposure to hormone replacement therapy, computed tomography, and prescription drugs.
The defendants denied the patients claims.
- The case settled for $1.7 million.
Patient not told of irregular mammography
<court>Undisclosed County (Minn)</court>
During a routine mammogram, a suspicious mass was noted, prompting the patient to undergo a biopsy. No cancer was detected. Following 2 postoperative visits, the woman was told to return a year later.
At mammography the following year, residual density was noted at the biopsy site. A follow-up mammogram was recommended, but though the physician examined the patient the following week, another mammogram was not conducted for 5 months. At that time the woman noted itching, thickening, and slight indentation of the breast.
The study revealed a 3-cm lesion, and surgical removal was recommended. However, the physician never told the patient of the irregularity, instead advising her to return in 6 months.
Five months later, the patient had moved from Minnesota to Nevada, where a new physician noted a breast mass on palpation and ordered a biopsy. The diagnosis was poorly differentiated Stage II ductal carcinoma. She underwent chemotherapy and radiation treatment, and at the time of the trial was disease free.
In suing, the woman alleged that had the defendant physician diagnosed her cancer in a timely fashion, she could have avoided radiation therapy and would have had a higher chance of cure.
- The jury awarded the patient $640,000.
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>Undisclosed County (Minn)</court>
During a routine mammogram, a suspicious mass was noted, prompting the patient to undergo a biopsy. No cancer was detected. Following 2 postoperative visits, the woman was told to return a year later.
At mammography the following year, residual density was noted at the biopsy site. A follow-up mammogram was recommended, but though the physician examined the patient the following week, another mammogram was not conducted for 5 months. At that time the woman noted itching, thickening, and slight indentation of the breast.
The study revealed a 3-cm lesion, and surgical removal was recommended. However, the physician never told the patient of the irregularity, instead advising her to return in 6 months.
Five months later, the patient had moved from Minnesota to Nevada, where a new physician noted a breast mass on palpation and ordered a biopsy. The diagnosis was poorly differentiated Stage II ductal carcinoma. She underwent chemotherapy and radiation treatment, and at the time of the trial was disease free.
In suing, the woman alleged that had the defendant physician diagnosed her cancer in a timely fashion, she could have avoided radiation therapy and would have had a higher chance of cure.
- The jury awarded the patient $640,000.
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>Undisclosed County (Minn)</court>
During a routine mammogram, a suspicious mass was noted, prompting the patient to undergo a biopsy. No cancer was detected. Following 2 postoperative visits, the woman was told to return a year later.
At mammography the following year, residual density was noted at the biopsy site. A follow-up mammogram was recommended, but though the physician examined the patient the following week, another mammogram was not conducted for 5 months. At that time the woman noted itching, thickening, and slight indentation of the breast.
The study revealed a 3-cm lesion, and surgical removal was recommended. However, the physician never told the patient of the irregularity, instead advising her to return in 6 months.
Five months later, the patient had moved from Minnesota to Nevada, where a new physician noted a breast mass on palpation and ordered a biopsy. The diagnosis was poorly differentiated Stage II ductal carcinoma. She underwent chemotherapy and radiation treatment, and at the time of the trial was disease free.
In suing, the woman alleged that had the defendant physician diagnosed her cancer in a timely fashion, she could have avoided radiation therapy and would have had a higher chance of cure.
- The jury awarded the patient $640,000.
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.
Bleeding, death follow D&C
Although begun on local anesthesia, a 49-year-old woman with a history of diabetes was switched to general anesthesia in the course of a dilatation and curettage (D&C).
Profuse hemorrhaging occurred during the procedure, causing reduced blood flow to the brain. Though resuscitated at that time, the woman died the following month due to irreversible brain damage.
In suing, her husband noted that the woman’s diabetes placed her at increased risk for blood loss. Further, he noted, blood tests taken 2 days prior to surgery revealed low hematocrit and hemoglobin levels. Together, these factors should have alerted medical staff to the possibility of intraoperative hemorrhage, prompting them to better prepare for such an event.
The defendants noted that bleeding can occur independent of negligence, and maintained that proper care was given.
- The defendant physicians settled for $1.2 million. The defendant hospital settled for an undisclosed sum.
Although begun on local anesthesia, a 49-year-old woman with a history of diabetes was switched to general anesthesia in the course of a dilatation and curettage (D&C).
Profuse hemorrhaging occurred during the procedure, causing reduced blood flow to the brain. Though resuscitated at that time, the woman died the following month due to irreversible brain damage.
In suing, her husband noted that the woman’s diabetes placed her at increased risk for blood loss. Further, he noted, blood tests taken 2 days prior to surgery revealed low hematocrit and hemoglobin levels. Together, these factors should have alerted medical staff to the possibility of intraoperative hemorrhage, prompting them to better prepare for such an event.
The defendants noted that bleeding can occur independent of negligence, and maintained that proper care was given.
- The defendant physicians settled for $1.2 million. The defendant hospital settled for an undisclosed sum.
Although begun on local anesthesia, a 49-year-old woman with a history of diabetes was switched to general anesthesia in the course of a dilatation and curettage (D&C).
Profuse hemorrhaging occurred during the procedure, causing reduced blood flow to the brain. Though resuscitated at that time, the woman died the following month due to irreversible brain damage.
In suing, her husband noted that the woman’s diabetes placed her at increased risk for blood loss. Further, he noted, blood tests taken 2 days prior to surgery revealed low hematocrit and hemoglobin levels. Together, these factors should have alerted medical staff to the possibility of intraoperative hemorrhage, prompting them to better prepare for such an event.
The defendants noted that bleeding can occur independent of negligence, and maintained that proper care was given.
- The defendant physicians settled for $1.2 million. The defendant hospital settled for an undisclosed sum.
Did negligence cause bladder injury at cesarean?
Due to a prolonged labor, an Ob/Gyn attempted vacuum then forceps delivery on a 35-year-old woman delivering her first child. When both interventions were unsuccessful, the physician opted for a cesarean section and delivered a healthy infant.
During the procedure, the mother suffered multiple bladder perforations, which caused urinary incontinence and sexual dysfunction.
She claimed the doctor was negligent in separating her bladder and uterus with Metzenbaum scissors.
The defense noted that due to adhesions from a prior abdominal cystectomy, the cesarean was especially difficult.
- The jury returned a defense verdict.
Due to a prolonged labor, an Ob/Gyn attempted vacuum then forceps delivery on a 35-year-old woman delivering her first child. When both interventions were unsuccessful, the physician opted for a cesarean section and delivered a healthy infant.
During the procedure, the mother suffered multiple bladder perforations, which caused urinary incontinence and sexual dysfunction.
She claimed the doctor was negligent in separating her bladder and uterus with Metzenbaum scissors.
The defense noted that due to adhesions from a prior abdominal cystectomy, the cesarean was especially difficult.
- The jury returned a defense verdict.
Due to a prolonged labor, an Ob/Gyn attempted vacuum then forceps delivery on a 35-year-old woman delivering her first child. When both interventions were unsuccessful, the physician opted for a cesarean section and delivered a healthy infant.
During the procedure, the mother suffered multiple bladder perforations, which caused urinary incontinence and sexual dysfunction.
She claimed the doctor was negligent in separating her bladder and uterus with Metzenbaum scissors.
The defense noted that due to adhesions from a prior abdominal cystectomy, the cesarean was especially difficult.
- The jury returned a defense verdict.