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Did inappropriate oxytocin cause uterine rupture?
A 30-year-old woman presented to a hospital in the early morning in labor with her first child; by phone, a physician ordered oxytocin administration.
The doctor instructed hospital staff to begin administration with 1 mU/min, with increases of 1 mU/min every 30 to 40 minutes. Despite this instruction, nurses increased the dose by 2 mU/min on 6 instances that day.
At approximately 1 PM, the physician performed an artificial rupture of membranes. At 5:30 PM, fetal monitoring revealed severe bradycardia; an emergency cesarean was performed 25 minutes later. Examination revealed uterine rupture. The child now suffers profound total-body spastic rigid cerebral palsy.
In suing, the plaintiffs noted that fetal monitoring strips showed decreased variability and repetitive late decelerations throughout the afternoon of delivery. They contended that the oxytocin dosage was increased on several occasions despite evidence of uterine hyperstimulation. Further, they claimed, the hyperstimulation resulted from inappropriate oxytocin administration.
The plaintiffs also argued that the Ob/Gyn should have noted dosing instructions were not being followed when she saw the patient at 1 PM; further, during a 4 PM phone call, the physician should have inquired as to the strength and frequency of contractions.
The doctor maintained it was the staff’s responsibility to carry out dosing orders as indicated and to inform the physician of any abnormalities in the labor.
The defendant hospital claimed that nurses are often called on to use discretion in dose increases, and that their actions were reasonable. Further, it was alleged, no clear indication of uterine hyperstimulation was present and abnormalities on the fetal monitoring strips were temporary. The hospital maintained the mother’s inherently weak uterus, not inappropriate oxytocin, was to blame for the rupture.
- The case settled for $4 million at mediation.
A 30-year-old woman presented to a hospital in the early morning in labor with her first child; by phone, a physician ordered oxytocin administration.
The doctor instructed hospital staff to begin administration with 1 mU/min, with increases of 1 mU/min every 30 to 40 minutes. Despite this instruction, nurses increased the dose by 2 mU/min on 6 instances that day.
At approximately 1 PM, the physician performed an artificial rupture of membranes. At 5:30 PM, fetal monitoring revealed severe bradycardia; an emergency cesarean was performed 25 minutes later. Examination revealed uterine rupture. The child now suffers profound total-body spastic rigid cerebral palsy.
In suing, the plaintiffs noted that fetal monitoring strips showed decreased variability and repetitive late decelerations throughout the afternoon of delivery. They contended that the oxytocin dosage was increased on several occasions despite evidence of uterine hyperstimulation. Further, they claimed, the hyperstimulation resulted from inappropriate oxytocin administration.
The plaintiffs also argued that the Ob/Gyn should have noted dosing instructions were not being followed when she saw the patient at 1 PM; further, during a 4 PM phone call, the physician should have inquired as to the strength and frequency of contractions.
The doctor maintained it was the staff’s responsibility to carry out dosing orders as indicated and to inform the physician of any abnormalities in the labor.
The defendant hospital claimed that nurses are often called on to use discretion in dose increases, and that their actions were reasonable. Further, it was alleged, no clear indication of uterine hyperstimulation was present and abnormalities on the fetal monitoring strips were temporary. The hospital maintained the mother’s inherently weak uterus, not inappropriate oxytocin, was to blame for the rupture.
- The case settled for $4 million at mediation.
A 30-year-old woman presented to a hospital in the early morning in labor with her first child; by phone, a physician ordered oxytocin administration.
The doctor instructed hospital staff to begin administration with 1 mU/min, with increases of 1 mU/min every 30 to 40 minutes. Despite this instruction, nurses increased the dose by 2 mU/min on 6 instances that day.
At approximately 1 PM, the physician performed an artificial rupture of membranes. At 5:30 PM, fetal monitoring revealed severe bradycardia; an emergency cesarean was performed 25 minutes later. Examination revealed uterine rupture. The child now suffers profound total-body spastic rigid cerebral palsy.
In suing, the plaintiffs noted that fetal monitoring strips showed decreased variability and repetitive late decelerations throughout the afternoon of delivery. They contended that the oxytocin dosage was increased on several occasions despite evidence of uterine hyperstimulation. Further, they claimed, the hyperstimulation resulted from inappropriate oxytocin administration.
The plaintiffs also argued that the Ob/Gyn should have noted dosing instructions were not being followed when she saw the patient at 1 PM; further, during a 4 PM phone call, the physician should have inquired as to the strength and frequency of contractions.
The doctor maintained it was the staff’s responsibility to carry out dosing orders as indicated and to inform the physician of any abnormalities in the labor.
The defendant hospital claimed that nurses are often called on to use discretion in dose increases, and that their actions were reasonable. Further, it was alleged, no clear indication of uterine hyperstimulation was present and abnormalities on the fetal monitoring strips were temporary. The hospital maintained the mother’s inherently weak uterus, not inappropriate oxytocin, was to blame for the rupture.
- The case settled for $4 million at mediation.
Vacuum suction blamed for severe retardation
During the course of delivery, a physician applied vacuum suction to a male child’s head 15 times. The child was born with cerebral palsy and severe mental retardation, with an estimated IQ of 25.
In suing, the plaintiff alleged that the suction caused constriction of internal veins, thus cutting off blood supply to the child’s brain.
The defense, noting a slightly elevated temperature in the mother during labor, maintained that the neonate’s injuries stemmed from a maternal condition.
- The judge awarded the plaintiff $19 million.
During the course of delivery, a physician applied vacuum suction to a male child’s head 15 times. The child was born with cerebral palsy and severe mental retardation, with an estimated IQ of 25.
In suing, the plaintiff alleged that the suction caused constriction of internal veins, thus cutting off blood supply to the child’s brain.
The defense, noting a slightly elevated temperature in the mother during labor, maintained that the neonate’s injuries stemmed from a maternal condition.
- The judge awarded the plaintiff $19 million.
During the course of delivery, a physician applied vacuum suction to a male child’s head 15 times. The child was born with cerebral palsy and severe mental retardation, with an estimated IQ of 25.
In suing, the plaintiff alleged that the suction caused constriction of internal veins, thus cutting off blood supply to the child’s brain.
The defense, noting a slightly elevated temperature in the mother during labor, maintained that the neonate’s injuries stemmed from a maternal condition.
- The judge awarded the plaintiff $19 million.
Low payment for cystectomy with oophorectomy
The operative report stated extensive work was involved. An 8-cm ovarian cyst was excised, and some cystic fluid aspirated. Should we appeal? Also, should we have added modifier -22 (unusual procedural services) to 58661?
Next: Code 58661 does not allow you to bill additionally for ovarian cyst removal or cystic fluid aspiration, because the physician also removed the ovary. However, there is 1 scenario in which additional reimbursement is possible.
An oophorectomy is by definition the removal of 1 ovary. For CPT codes in which oophorectomy is an integral part of the procedure (eg, total abdominal hysterectomy/bilateral salpingo-oophorectomy, open oophorectomy, open salpingo-oophorectomy) the language indicates whether they are used to report a partial or total unilateral or bilateral removal. Code 58661, however, only indicates “partial or total oophorectomy”—leading to the belief that it applies to only 1 side, not both.
If a physician removes the ovary on 1 side, but removes an ovarian cyst on the other, and if the payer agrees with this interpretation of the code, you might be able to bill both 58661 and 58662 (which covers both removal and aspiration of the ovarian cyst), placing the modifiers -RT (right side) and -LT (left side) as appropriate. Still, many payers—including Medicare—do not agree with this interpretation and will not reimburse in this manner.
Your question, however, indicates that both ovaries were removed. Thus, additional reimbursement is unlikely.
Ms. Witt, former program manager in the Department of Coding and Nomenclature at the American College of Obstetricians and Gynecologists, is an independent coding and documentation consultant. Reimbursement Adviser reflects the most commonly accepted interpretations of CPT-4 and ICD-9-CM coding. When in doubt on a coding or billing matter, check with your individual payer.
The operative report stated extensive work was involved. An 8-cm ovarian cyst was excised, and some cystic fluid aspirated. Should we appeal? Also, should we have added modifier -22 (unusual procedural services) to 58661?
Next: Code 58661 does not allow you to bill additionally for ovarian cyst removal or cystic fluid aspiration, because the physician also removed the ovary. However, there is 1 scenario in which additional reimbursement is possible.
An oophorectomy is by definition the removal of 1 ovary. For CPT codes in which oophorectomy is an integral part of the procedure (eg, total abdominal hysterectomy/bilateral salpingo-oophorectomy, open oophorectomy, open salpingo-oophorectomy) the language indicates whether they are used to report a partial or total unilateral or bilateral removal. Code 58661, however, only indicates “partial or total oophorectomy”—leading to the belief that it applies to only 1 side, not both.
If a physician removes the ovary on 1 side, but removes an ovarian cyst on the other, and if the payer agrees with this interpretation of the code, you might be able to bill both 58661 and 58662 (which covers both removal and aspiration of the ovarian cyst), placing the modifiers -RT (right side) and -LT (left side) as appropriate. Still, many payers—including Medicare—do not agree with this interpretation and will not reimburse in this manner.
Your question, however, indicates that both ovaries were removed. Thus, additional reimbursement is unlikely.
Ms. Witt, former program manager in the Department of Coding and Nomenclature at the American College of Obstetricians and Gynecologists, is an independent coding and documentation consultant. Reimbursement Adviser reflects the most commonly accepted interpretations of CPT-4 and ICD-9-CM coding. When in doubt on a coding or billing matter, check with your individual payer.
The operative report stated extensive work was involved. An 8-cm ovarian cyst was excised, and some cystic fluid aspirated. Should we appeal? Also, should we have added modifier -22 (unusual procedural services) to 58661?
Next: Code 58661 does not allow you to bill additionally for ovarian cyst removal or cystic fluid aspiration, because the physician also removed the ovary. However, there is 1 scenario in which additional reimbursement is possible.
An oophorectomy is by definition the removal of 1 ovary. For CPT codes in which oophorectomy is an integral part of the procedure (eg, total abdominal hysterectomy/bilateral salpingo-oophorectomy, open oophorectomy, open salpingo-oophorectomy) the language indicates whether they are used to report a partial or total unilateral or bilateral removal. Code 58661, however, only indicates “partial or total oophorectomy”—leading to the belief that it applies to only 1 side, not both.
If a physician removes the ovary on 1 side, but removes an ovarian cyst on the other, and if the payer agrees with this interpretation of the code, you might be able to bill both 58661 and 58662 (which covers both removal and aspiration of the ovarian cyst), placing the modifiers -RT (right side) and -LT (left side) as appropriate. Still, many payers—including Medicare—do not agree with this interpretation and will not reimburse in this manner.
Your question, however, indicates that both ovaries were removed. Thus, additional reimbursement is unlikely.
Ms. Witt, former program manager in the Department of Coding and Nomenclature at the American College of Obstetricians and Gynecologists, is an independent coding and documentation consultant. Reimbursement Adviser reflects the most commonly accepted interpretations of CPT-4 and ICD-9-CM coding. When in doubt on a coding or billing matter, check with your individual payer.
Hydrodistention, cystoscopy: Why and what code?
During cystoscopy, the inside of the bladder is examined. Then the bladder is filled to a high pressure with fluid (hydrodistended). This causes the bladder wall to stretch, allowing the physician to inspect for changes typical of interstitial cystitis. Hydrodistention may reduce pain and discomfort in some interstitial cystitis patients, and thus may be therapeutic as well as diagnostic.
For this procedure, code either 52260 (Cystourethroscopy, with dilation of bladder for interstitial cystitis; general or conduction [spinal] anesthesia) or 52265 (…with local anesthesia). Be sure to verify the anesthesia type before billing for this service.
Ms. Witt, former program manager in the Department of Coding and Nomenclature at the American College of Obstetricians and Gynecologists, is an independent coding and documentation consultant. Reimbursement Adviser reflects the most commonly accepted interpretations of CPT-4 and ICD-9-CM coding. When in doubt on a coding or billing matter, check with your individual payer.
During cystoscopy, the inside of the bladder is examined. Then the bladder is filled to a high pressure with fluid (hydrodistended). This causes the bladder wall to stretch, allowing the physician to inspect for changes typical of interstitial cystitis. Hydrodistention may reduce pain and discomfort in some interstitial cystitis patients, and thus may be therapeutic as well as diagnostic.
For this procedure, code either 52260 (Cystourethroscopy, with dilation of bladder for interstitial cystitis; general or conduction [spinal] anesthesia) or 52265 (…with local anesthesia). Be sure to verify the anesthesia type before billing for this service.
Ms. Witt, former program manager in the Department of Coding and Nomenclature at the American College of Obstetricians and Gynecologists, is an independent coding and documentation consultant. Reimbursement Adviser reflects the most commonly accepted interpretations of CPT-4 and ICD-9-CM coding. When in doubt on a coding or billing matter, check with your individual payer.
During cystoscopy, the inside of the bladder is examined. Then the bladder is filled to a high pressure with fluid (hydrodistended). This causes the bladder wall to stretch, allowing the physician to inspect for changes typical of interstitial cystitis. Hydrodistention may reduce pain and discomfort in some interstitial cystitis patients, and thus may be therapeutic as well as diagnostic.
For this procedure, code either 52260 (Cystourethroscopy, with dilation of bladder for interstitial cystitis; general or conduction [spinal] anesthesia) or 52265 (…with local anesthesia). Be sure to verify the anesthesia type before billing for this service.
Ms. Witt, former program manager in the Department of Coding and Nomenclature at the American College of Obstetricians and Gynecologists, is an independent coding and documentation consultant. Reimbursement Adviser reflects the most commonly accepted interpretations of CPT-4 and ICD-9-CM coding. When in doubt on a coding or billing matter, check with your individual payer.
Oophorectomy due to hemorrhage leads to surgical menopause
After 3 years of conservative treatment for recurring intense pain stemming from fibroids, a 41-year-old woman underwent a laparoscopic-assisted vaginal hysterectomy.
Twelve hours after surgery, the woman began to hemorrhage. A laparotomy identified the woman’s right ovary as the source of the bleeding. An oophorectomy was performed.
The plaintiff argued that her right ovary was improperly removed, leading to surgical menopause. She also alleged that the hysterectomy itself was not clinically indicated.
The defendant physician not only claimed the hysterectomy was indicated given the woman’s history, but also noted that the patient specifically requested the procedure. Further, the Ob/Gyn maintained that the oophorectomy was properly performed, and that the remaining ovary should have supplied adequate hormones.
- The jury returned a defense verdict.
After 3 years of conservative treatment for recurring intense pain stemming from fibroids, a 41-year-old woman underwent a laparoscopic-assisted vaginal hysterectomy.
Twelve hours after surgery, the woman began to hemorrhage. A laparotomy identified the woman’s right ovary as the source of the bleeding. An oophorectomy was performed.
The plaintiff argued that her right ovary was improperly removed, leading to surgical menopause. She also alleged that the hysterectomy itself was not clinically indicated.
The defendant physician not only claimed the hysterectomy was indicated given the woman’s history, but also noted that the patient specifically requested the procedure. Further, the Ob/Gyn maintained that the oophorectomy was properly performed, and that the remaining ovary should have supplied adequate hormones.
- The jury returned a defense verdict.
After 3 years of conservative treatment for recurring intense pain stemming from fibroids, a 41-year-old woman underwent a laparoscopic-assisted vaginal hysterectomy.
Twelve hours after surgery, the woman began to hemorrhage. A laparotomy identified the woman’s right ovary as the source of the bleeding. An oophorectomy was performed.
The plaintiff argued that her right ovary was improperly removed, leading to surgical menopause. She also alleged that the hysterectomy itself was not clinically indicated.
The defendant physician not only claimed the hysterectomy was indicated given the woman’s history, but also noted that the patient specifically requested the procedure. Further, the Ob/Gyn maintained that the oophorectomy was properly performed, and that the remaining ovary should have supplied adequate hormones.
- The jury returned a defense verdict.
Sponge overlooked, but during which cesarean?
Nine months after her second cesarean, a 44-year-old-woman presented to her Ob/Gyn with persistent cramping and abdominal pain. After a series of tests, the physician diagnosed endometritis.
When the patient reported persistent symptoms a year later, the doctor ordered a computed tomography scan; the study showed a large mass in the woman’s uterus. An emergency laparotomy revealed an 18-by-18-inch sponge, which the doctor removed. He also discovered an abscess that required a hysterectomy.
The woman sued, claiming the sponge was left during her second cesarean delivery.
The defendant hospital, however, argued the sponge was actually forgotten during her first cesarean. As proof, the defense presented testimony from the head nurse at the time of second procedure. She claimed to be a meticulous counter, and testified that she specifically recalled that the sponge count on the second cesarean was correct.
Although the first procedure was also conducted at the defendant institution, the defense claimed that the statute of limitations had expired.
- The jury awarded the plaintiff $500,000.
Nine months after her second cesarean, a 44-year-old-woman presented to her Ob/Gyn with persistent cramping and abdominal pain. After a series of tests, the physician diagnosed endometritis.
When the patient reported persistent symptoms a year later, the doctor ordered a computed tomography scan; the study showed a large mass in the woman’s uterus. An emergency laparotomy revealed an 18-by-18-inch sponge, which the doctor removed. He also discovered an abscess that required a hysterectomy.
The woman sued, claiming the sponge was left during her second cesarean delivery.
The defendant hospital, however, argued the sponge was actually forgotten during her first cesarean. As proof, the defense presented testimony from the head nurse at the time of second procedure. She claimed to be a meticulous counter, and testified that she specifically recalled that the sponge count on the second cesarean was correct.
Although the first procedure was also conducted at the defendant institution, the defense claimed that the statute of limitations had expired.
- The jury awarded the plaintiff $500,000.
Nine months after her second cesarean, a 44-year-old-woman presented to her Ob/Gyn with persistent cramping and abdominal pain. After a series of tests, the physician diagnosed endometritis.
When the patient reported persistent symptoms a year later, the doctor ordered a computed tomography scan; the study showed a large mass in the woman’s uterus. An emergency laparotomy revealed an 18-by-18-inch sponge, which the doctor removed. He also discovered an abscess that required a hysterectomy.
The woman sued, claiming the sponge was left during her second cesarean delivery.
The defendant hospital, however, argued the sponge was actually forgotten during her first cesarean. As proof, the defense presented testimony from the head nurse at the time of second procedure. She claimed to be a meticulous counter, and testified that she specifically recalled that the sponge count on the second cesarean was correct.
Although the first procedure was also conducted at the defendant institution, the defense claimed that the statute of limitations had expired.
- The jury awarded the plaintiff $500,000.
Tocolytics not given for preterm labor
Nine hours after presenting to an emergency department with labor contractions, a woman at 30 weeks’ gestation delivered a son. The child was born paralyzed after suffering an intraventricular hemorrhage.
The woman sued, claiming that she should have received tocolytics to prevent preterm birth, as well as corticosteroids to reduce the risk of birth defects.
The defendant claimed the woman had begun leaking amniotic fluid before she arrived at the hospital. Had she been given tocolytics, it was argued, the risk of infection to both mother and child would have risen dramatically.
Further, it was noted that when the incident took place, in 1990, administration of corticosteroids was not yet the standard of care in cases such as this.
- The jury returned a defense verdict.
Nine hours after presenting to an emergency department with labor contractions, a woman at 30 weeks’ gestation delivered a son. The child was born paralyzed after suffering an intraventricular hemorrhage.
The woman sued, claiming that she should have received tocolytics to prevent preterm birth, as well as corticosteroids to reduce the risk of birth defects.
The defendant claimed the woman had begun leaking amniotic fluid before she arrived at the hospital. Had she been given tocolytics, it was argued, the risk of infection to both mother and child would have risen dramatically.
Further, it was noted that when the incident took place, in 1990, administration of corticosteroids was not yet the standard of care in cases such as this.
- The jury returned a defense verdict.
Nine hours after presenting to an emergency department with labor contractions, a woman at 30 weeks’ gestation delivered a son. The child was born paralyzed after suffering an intraventricular hemorrhage.
The woman sued, claiming that she should have received tocolytics to prevent preterm birth, as well as corticosteroids to reduce the risk of birth defects.
The defendant claimed the woman had begun leaking amniotic fluid before she arrived at the hospital. Had she been given tocolytics, it was argued, the risk of infection to both mother and child would have risen dramatically.
Further, it was noted that when the incident took place, in 1990, administration of corticosteroids was not yet the standard of care in cases such as this.
- The jury returned a defense verdict.
Prior tracheotomy delays crash cesarean
After calling her physician with complaints of decreased fetal movement, a woman at 32 weeks’ gestation presented to the hospital. Fetal heart tracings were nonreassuring and an ultrasound biophysical profile was scored at 0/8. An emergency cesarean was ordered.
The patient, as a child, had had a tracheotomy, but the defendant Ob/Gyn never informed the anesthesiologist of this history. This led to complications in the attempts to intubate the mother, and thus delayed the delivery. The child now suffers cerebral palsy.
- The case settled for $8 million.
After calling her physician with complaints of decreased fetal movement, a woman at 32 weeks’ gestation presented to the hospital. Fetal heart tracings were nonreassuring and an ultrasound biophysical profile was scored at 0/8. An emergency cesarean was ordered.
The patient, as a child, had had a tracheotomy, but the defendant Ob/Gyn never informed the anesthesiologist of this history. This led to complications in the attempts to intubate the mother, and thus delayed the delivery. The child now suffers cerebral palsy.
- The case settled for $8 million.
After calling her physician with complaints of decreased fetal movement, a woman at 32 weeks’ gestation presented to the hospital. Fetal heart tracings were nonreassuring and an ultrasound biophysical profile was scored at 0/8. An emergency cesarean was ordered.
The patient, as a child, had had a tracheotomy, but the defendant Ob/Gyn never informed the anesthesiologist of this history. This led to complications in the attempts to intubate the mother, and thus delayed the delivery. The child now suffers cerebral palsy.
- The case settled for $8 million.
Laboring mother sent home; child suffers hypoxic insult
A woman at term in her second pregnancy presented to a hospital with contractions 3 to 5 minutes apart. Upon examination, her Ob/Gyn established she was 1 cm dilated and 50% effaced, with the fetus at –2 station.
As the night progressed, however, the woman’s contractions became further apart. The physician opted to send her home (a drive of more than 30 minutes)—despite the fact that electronic fetal monitoring revealed nonreactive tracings, and over the patient’s protests that her last delivery occurred very quickly once active labor began.
The next morning, the patient once again presented with contractions 3 to 5 minutes apart. Twenty minutes later she delivered the infant, who at birth was floppy and cyanotic and exhibited no spontaneous respirations or movements.
The medical record made no note of the care administered until 20 minutes after the child’s birth, when he was admitted to the neonatal intensive care unit. The infant was intubated; however, a chest x-ray showed that the tube had been placed down the right mainstem bronchus, and the left lung had collapsed. Still, tube repositioning did not occur until 30 minutes after the initial placement and needle aspiration for the pneumothorax was not done for another 10 minutes.
Subsequent radiologic studies indicated diffuse hypoxic insult. The child at age 5 was cortically blind; had significant hypotonia; and was unable to walk, talk, or engage in any purposeful activities.
- The case settled for $1.2 million.
A woman at term in her second pregnancy presented to a hospital with contractions 3 to 5 minutes apart. Upon examination, her Ob/Gyn established she was 1 cm dilated and 50% effaced, with the fetus at –2 station.
As the night progressed, however, the woman’s contractions became further apart. The physician opted to send her home (a drive of more than 30 minutes)—despite the fact that electronic fetal monitoring revealed nonreactive tracings, and over the patient’s protests that her last delivery occurred very quickly once active labor began.
The next morning, the patient once again presented with contractions 3 to 5 minutes apart. Twenty minutes later she delivered the infant, who at birth was floppy and cyanotic and exhibited no spontaneous respirations or movements.
The medical record made no note of the care administered until 20 minutes after the child’s birth, when he was admitted to the neonatal intensive care unit. The infant was intubated; however, a chest x-ray showed that the tube had been placed down the right mainstem bronchus, and the left lung had collapsed. Still, tube repositioning did not occur until 30 minutes after the initial placement and needle aspiration for the pneumothorax was not done for another 10 minutes.
Subsequent radiologic studies indicated diffuse hypoxic insult. The child at age 5 was cortically blind; had significant hypotonia; and was unable to walk, talk, or engage in any purposeful activities.
- The case settled for $1.2 million.
A woman at term in her second pregnancy presented to a hospital with contractions 3 to 5 minutes apart. Upon examination, her Ob/Gyn established she was 1 cm dilated and 50% effaced, with the fetus at –2 station.
As the night progressed, however, the woman’s contractions became further apart. The physician opted to send her home (a drive of more than 30 minutes)—despite the fact that electronic fetal monitoring revealed nonreactive tracings, and over the patient’s protests that her last delivery occurred very quickly once active labor began.
The next morning, the patient once again presented with contractions 3 to 5 minutes apart. Twenty minutes later she delivered the infant, who at birth was floppy and cyanotic and exhibited no spontaneous respirations or movements.
The medical record made no note of the care administered until 20 minutes after the child’s birth, when he was admitted to the neonatal intensive care unit. The infant was intubated; however, a chest x-ray showed that the tube had been placed down the right mainstem bronchus, and the left lung had collapsed. Still, tube repositioning did not occur until 30 minutes after the initial placement and needle aspiration for the pneumothorax was not done for another 10 minutes.
Subsequent radiologic studies indicated diffuse hypoxic insult. The child at age 5 was cortically blind; had significant hypotonia; and was unable to walk, talk, or engage in any purposeful activities.
- The case settled for $1.2 million.
Asymmetrical breasts: Common but cosmetic
The congenital cause is called Poland’s Syndrome. With this condition not only is one breast underdeveloped, but the same-side hand also exhibits anomalies. Clearly, the physician would need to confirm this diagnosis. Code 757.6 (specified anomalies of breast) would work for this syndrome, as well as for cases with documented hypoplasia of the breast.
Another cause of asymmetry might be infection, trauma, or surgery near the developing breast when the patient was a child. For instance, if the patient had a history of a wound and the current breast asymmetry is considered a “late effect” of that wound, you might code 906.0 (late effect of open wound of head, neck, and trunk).
When the cause of the complaint of asymmetry is unknown, consider using 611.79 (other signs and symptoms in breast).
Some women are very sensitive to differences in breast size and want to correct the appearance with a prosthetic bra or surgery. Just make sure that the documentation supports any diagnostic code you use and clearly indicates whether the treatment is cosmetic.
Ms. Witt, former program manager in the Department of Coding and Nomenclature at the American College of Obstetricians and Gynecologists, is an independent coding and documentation consultant. Reimbursement Adviser reflects the most commonly accepted interpretations of CPT-4 and ICD-9-CM coding. When in doubt on a coding or billing matter, check with your individual payer.
The congenital cause is called Poland’s Syndrome. With this condition not only is one breast underdeveloped, but the same-side hand also exhibits anomalies. Clearly, the physician would need to confirm this diagnosis. Code 757.6 (specified anomalies of breast) would work for this syndrome, as well as for cases with documented hypoplasia of the breast.
Another cause of asymmetry might be infection, trauma, or surgery near the developing breast when the patient was a child. For instance, if the patient had a history of a wound and the current breast asymmetry is considered a “late effect” of that wound, you might code 906.0 (late effect of open wound of head, neck, and trunk).
When the cause of the complaint of asymmetry is unknown, consider using 611.79 (other signs and symptoms in breast).
Some women are very sensitive to differences in breast size and want to correct the appearance with a prosthetic bra or surgery. Just make sure that the documentation supports any diagnostic code you use and clearly indicates whether the treatment is cosmetic.
Ms. Witt, former program manager in the Department of Coding and Nomenclature at the American College of Obstetricians and Gynecologists, is an independent coding and documentation consultant. Reimbursement Adviser reflects the most commonly accepted interpretations of CPT-4 and ICD-9-CM coding. When in doubt on a coding or billing matter, check with your individual payer.
The congenital cause is called Poland’s Syndrome. With this condition not only is one breast underdeveloped, but the same-side hand also exhibits anomalies. Clearly, the physician would need to confirm this diagnosis. Code 757.6 (specified anomalies of breast) would work for this syndrome, as well as for cases with documented hypoplasia of the breast.
Another cause of asymmetry might be infection, trauma, or surgery near the developing breast when the patient was a child. For instance, if the patient had a history of a wound and the current breast asymmetry is considered a “late effect” of that wound, you might code 906.0 (late effect of open wound of head, neck, and trunk).
When the cause of the complaint of asymmetry is unknown, consider using 611.79 (other signs and symptoms in breast).
Some women are very sensitive to differences in breast size and want to correct the appearance with a prosthetic bra or surgery. Just make sure that the documentation supports any diagnostic code you use and clearly indicates whether the treatment is cosmetic.
Ms. Witt, former program manager in the Department of Coding and Nomenclature at the American College of Obstetricians and Gynecologists, is an independent coding and documentation consultant. Reimbursement Adviser reflects the most commonly accepted interpretations of CPT-4 and ICD-9-CM coding. When in doubt on a coding or billing matter, check with your individual payer.