5-month follow-up after cancer resection

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Q Five months after surgery to remove endometrial cancer, a patient came in for a follow-up visit. Since the 90-day follow-up period had passed, we billed for an office visit. The diagnostic codes used were V10.42 (personal history of endometrial cancer) and V76.2 (special screening for malignant neoplasms, cervix) for Pap screening. Because ICD-9 marks V10.42 as a secondary diagnosis, however, I fear this may be incorrect. Is it?

A Before answering this question, we need to better define the situation by making some assumptions. First, I will assume that the surgery involved removing the uterus as well as the cervix.

Second, I presume that the surgeon does not consider the patient cancer-free. ICD-9 states that a diagnosis of “personal history of cancer” is made only after all treatment is completed. At 5 months postsurgery, I am not sure this would be true—at least until 2 or 3 normal Pap interpretations assure the physician that the original cancer is gone.

And third, I assume the patient is not a Medicare beneficiary, which further changes the coding rules.

I would code the visit’s primary diagnosis as endometrial cancer, with a secondary diagnosis of V67.01 (follow-up vaginal Pap smear). This code was created to report a vaginal Pap smear after a hysterectomy for malignancy.

Once you have obtained 2 or more negative Pap results, you can use V67.01 as the primary diagnosis and V10.42 as the secondary diagnosis for each Pap smear encounter. This will take care of the ICD-9 rule stating you cannot report a “personal history” V code as the primary diagnosis.

If the patient still has her cervix, use the code for endometrial cancer for the visit’s diagnostic Pap. Once you have 2 or 3 normal Pap results, you can revert to V76.2 for the Pap interpretation. You would use this as the primary code and V10.42 for the secondary diagnosis. Note some payers will allow you to bill for a handling fee using 99000.

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Q Five months after surgery to remove endometrial cancer, a patient came in for a follow-up visit. Since the 90-day follow-up period had passed, we billed for an office visit. The diagnostic codes used were V10.42 (personal history of endometrial cancer) and V76.2 (special screening for malignant neoplasms, cervix) for Pap screening. Because ICD-9 marks V10.42 as a secondary diagnosis, however, I fear this may be incorrect. Is it?

A Before answering this question, we need to better define the situation by making some assumptions. First, I will assume that the surgery involved removing the uterus as well as the cervix.

Second, I presume that the surgeon does not consider the patient cancer-free. ICD-9 states that a diagnosis of “personal history of cancer” is made only after all treatment is completed. At 5 months postsurgery, I am not sure this would be true—at least until 2 or 3 normal Pap interpretations assure the physician that the original cancer is gone.

And third, I assume the patient is not a Medicare beneficiary, which further changes the coding rules.

I would code the visit’s primary diagnosis as endometrial cancer, with a secondary diagnosis of V67.01 (follow-up vaginal Pap smear). This code was created to report a vaginal Pap smear after a hysterectomy for malignancy.

Once you have obtained 2 or more negative Pap results, you can use V67.01 as the primary diagnosis and V10.42 as the secondary diagnosis for each Pap smear encounter. This will take care of the ICD-9 rule stating you cannot report a “personal history” V code as the primary diagnosis.

If the patient still has her cervix, use the code for endometrial cancer for the visit’s diagnostic Pap. Once you have 2 or 3 normal Pap results, you can revert to V76.2 for the Pap interpretation. You would use this as the primary code and V10.42 for the secondary diagnosis. Note some payers will allow you to bill for a handling fee using 99000.

Q Five months after surgery to remove endometrial cancer, a patient came in for a follow-up visit. Since the 90-day follow-up period had passed, we billed for an office visit. The diagnostic codes used were V10.42 (personal history of endometrial cancer) and V76.2 (special screening for malignant neoplasms, cervix) for Pap screening. Because ICD-9 marks V10.42 as a secondary diagnosis, however, I fear this may be incorrect. Is it?

A Before answering this question, we need to better define the situation by making some assumptions. First, I will assume that the surgery involved removing the uterus as well as the cervix.

Second, I presume that the surgeon does not consider the patient cancer-free. ICD-9 states that a diagnosis of “personal history of cancer” is made only after all treatment is completed. At 5 months postsurgery, I am not sure this would be true—at least until 2 or 3 normal Pap interpretations assure the physician that the original cancer is gone.

And third, I assume the patient is not a Medicare beneficiary, which further changes the coding rules.

I would code the visit’s primary diagnosis as endometrial cancer, with a secondary diagnosis of V67.01 (follow-up vaginal Pap smear). This code was created to report a vaginal Pap smear after a hysterectomy for malignancy.

Once you have obtained 2 or more negative Pap results, you can use V67.01 as the primary diagnosis and V10.42 as the secondary diagnosis for each Pap smear encounter. This will take care of the ICD-9 rule stating you cannot report a “personal history” V code as the primary diagnosis.

If the patient still has her cervix, use the code for endometrial cancer for the visit’s diagnostic Pap. Once you have 2 or 3 normal Pap results, you can revert to V76.2 for the Pap interpretation. You would use this as the primary code and V10.42 for the secondary diagnosis. Note some payers will allow you to bill for a handling fee using 99000.

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Screening after abnormal Pap: ‘Problem, not preventive’

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Q One frustrating problem we frequently encounter is when the doctor wants a patient with a recent abnormal Pap to return every 6 months for repeat cytology.

Payers do not recognize Q0091 (screening Papanicolaou smear; obtaining, preparing and conveyance of cervical or vaginal smear to laboratory) with the appropriate evaluation/management (E/M) code and with 795.0X (abnormal Pap smear) as the diagnosis. Because a Pap is not a routine procedure with our E/M visits, we typically bill out the Q0091 code.

A follow-up abnormal Pap is a problem—not a preventive—E/M service. Collection is part of the exam and not coded separately.

One insurance company told me I should use laboratory codes 88142-88150. Any advice?

A The American College of Obstetricians and Gynecologists (ACOG) takes the position that specimen collection at the time of the pelvic exam should not be billed separately—but Q0091, a Healthcare Common Procedure Coding System (HCPCS) code, was created by Medicare for use with Medicare patients.

It was developed in a time when Medicare did not cover annual preventive gynecologic examinations, but did pay laboratories for interpreting cervical smears collected at these preventive visits. Medicare wanted to give physicians some reimbursement for their time spent collecting the specimen. In 1998 Medicare began covering pelvic and breast exams, but continued to pay for specimen collection for screening Pap smears.

A follow-up abnormal Pap, however, is billed as a problem—not a preventive—E/M service. In this case, Medicare agrees with ACOG that the collection is part of the exam and not coded separately.

Many private payers have also adopted this view—even those that formerly reimbursed a small fee for collection with code 99000 (handling and/or conveyance of specimen for transfer from the physician’s office to a laboratory).

Under no circumstance should a laboratory code be billed for collecting the specimen.

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Q One frustrating problem we frequently encounter is when the doctor wants a patient with a recent abnormal Pap to return every 6 months for repeat cytology.

Payers do not recognize Q0091 (screening Papanicolaou smear; obtaining, preparing and conveyance of cervical or vaginal smear to laboratory) with the appropriate evaluation/management (E/M) code and with 795.0X (abnormal Pap smear) as the diagnosis. Because a Pap is not a routine procedure with our E/M visits, we typically bill out the Q0091 code.

A follow-up abnormal Pap is a problem—not a preventive—E/M service. Collection is part of the exam and not coded separately.

One insurance company told me I should use laboratory codes 88142-88150. Any advice?

A The American College of Obstetricians and Gynecologists (ACOG) takes the position that specimen collection at the time of the pelvic exam should not be billed separately—but Q0091, a Healthcare Common Procedure Coding System (HCPCS) code, was created by Medicare for use with Medicare patients.

It was developed in a time when Medicare did not cover annual preventive gynecologic examinations, but did pay laboratories for interpreting cervical smears collected at these preventive visits. Medicare wanted to give physicians some reimbursement for their time spent collecting the specimen. In 1998 Medicare began covering pelvic and breast exams, but continued to pay for specimen collection for screening Pap smears.

A follow-up abnormal Pap, however, is billed as a problem—not a preventive—E/M service. In this case, Medicare agrees with ACOG that the collection is part of the exam and not coded separately.

Many private payers have also adopted this view—even those that formerly reimbursed a small fee for collection with code 99000 (handling and/or conveyance of specimen for transfer from the physician’s office to a laboratory).

Under no circumstance should a laboratory code be billed for collecting the specimen.

Q One frustrating problem we frequently encounter is when the doctor wants a patient with a recent abnormal Pap to return every 6 months for repeat cytology.

Payers do not recognize Q0091 (screening Papanicolaou smear; obtaining, preparing and conveyance of cervical or vaginal smear to laboratory) with the appropriate evaluation/management (E/M) code and with 795.0X (abnormal Pap smear) as the diagnosis. Because a Pap is not a routine procedure with our E/M visits, we typically bill out the Q0091 code.

A follow-up abnormal Pap is a problem—not a preventive—E/M service. Collection is part of the exam and not coded separately.

One insurance company told me I should use laboratory codes 88142-88150. Any advice?

A The American College of Obstetricians and Gynecologists (ACOG) takes the position that specimen collection at the time of the pelvic exam should not be billed separately—but Q0091, a Healthcare Common Procedure Coding System (HCPCS) code, was created by Medicare for use with Medicare patients.

It was developed in a time when Medicare did not cover annual preventive gynecologic examinations, but did pay laboratories for interpreting cervical smears collected at these preventive visits. Medicare wanted to give physicians some reimbursement for their time spent collecting the specimen. In 1998 Medicare began covering pelvic and breast exams, but continued to pay for specimen collection for screening Pap smears.

A follow-up abnormal Pap, however, is billed as a problem—not a preventive—E/M service. In this case, Medicare agrees with ACOG that the collection is part of the exam and not coded separately.

Many private payers have also adopted this view—even those that formerly reimbursed a small fee for collection with code 99000 (handling and/or conveyance of specimen for transfer from the physician’s office to a laboratory).

Under no circumstance should a laboratory code be billed for collecting the specimen.

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Vaginal bleeding after the postpartum period

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Q I need a diagnosis code for vaginal bleeding 8 weeks postpartum. The physician says it is possibly retained products of conception. How would I code this?

A The standard postpartum period is 6 weeks. Beyond that time you can report this as a late effect of pregnancy (677)—however, since this code cannot be used as a primary diagnosis, you must look for another code to explain the symptom.

If there is a finding of retained products of conception, use 667.04 (retained placenta without hemorrhage) or 667.14 (retained portions of placenta or membranes, without hemorrhage) along with 677.

If the report shows no products but the physician believes the bleeding is related to pregnancy, your choices include:

  • 665.34 for a laceration on the cervix,
  • 665.74 for a hematoma of the vagina,
  • 665.84 for some “other” specified obstetrical trauma, or
  • 665.94 for an unspecified trauma.

If none of these fit or if the bleeding turns out to be unrelated to the pregnancy, bill 626.8 from the Gyn chapter for other dysfunctional bleeding.

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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.

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Q I need a diagnosis code for vaginal bleeding 8 weeks postpartum. The physician says it is possibly retained products of conception. How would I code this?

A The standard postpartum period is 6 weeks. Beyond that time you can report this as a late effect of pregnancy (677)—however, since this code cannot be used as a primary diagnosis, you must look for another code to explain the symptom.

If there is a finding of retained products of conception, use 667.04 (retained placenta without hemorrhage) or 667.14 (retained portions of placenta or membranes, without hemorrhage) along with 677.

If the report shows no products but the physician believes the bleeding is related to pregnancy, your choices include:

  • 665.34 for a laceration on the cervix,
  • 665.74 for a hematoma of the vagina,
  • 665.84 for some “other” specified obstetrical trauma, or
  • 665.94 for an unspecified trauma.

If none of these fit or if the bleeding turns out to be unrelated to the pregnancy, bill 626.8 from the Gyn chapter for other dysfunctional bleeding.

Q I need a diagnosis code for vaginal bleeding 8 weeks postpartum. The physician says it is possibly retained products of conception. How would I code this?

A The standard postpartum period is 6 weeks. Beyond that time you can report this as a late effect of pregnancy (677)—however, since this code cannot be used as a primary diagnosis, you must look for another code to explain the symptom.

If there is a finding of retained products of conception, use 667.04 (retained placenta without hemorrhage) or 667.14 (retained portions of placenta or membranes, without hemorrhage) along with 677.

If the report shows no products but the physician believes the bleeding is related to pregnancy, your choices include:

  • 665.34 for a laceration on the cervix,
  • 665.74 for a hematoma of the vagina,
  • 665.84 for some “other” specified obstetrical trauma, or
  • 665.94 for an unspecified trauma.

If none of these fit or if the bleeding turns out to be unrelated to the pregnancy, bill 626.8 from the Gyn chapter for other dysfunctional bleeding.

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Does morcellation change hysterectomy coding?

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Q My physician performed a laparoscopic supracervical hysterectomy with morcellation. Would I bill 58550-52?

A This question has 2 parts: how to bill for a laparoscopic supracervical hysterectomy, and how to account for the morcellation.

Currently, no code exists for laparoscopic supracervical hysterectomy. Your proposed choice, 58550-52 (laparoscopy surgical; with vaginal hysterectomy for uterus 250 grams or less; reduced service), is sometimes used, but payers just as frequently accept unlisted code 58578 (unlisted laparoscopy procedure, uterus). The latter option, with documentation, sometimes results in prompter and fairer reimbursement over the -52 modifier option. The reason: The procedure is more completely described via the submitted documentation, and payers are less likely to reduce their allowable, even though the cervix was left in place.

When morcellation of the uterus is performed, however, the situation changes: This technique is performed to shred and extract a very large uterus, and CPT has a code (58553) for laparoscopic vaginal hysterectomy for a uterus weighing more than 250 g. Thus, your options would be to bill either 58553-52 or the unlisted code 58578.

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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.

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Q My physician performed a laparoscopic supracervical hysterectomy with morcellation. Would I bill 58550-52?

A This question has 2 parts: how to bill for a laparoscopic supracervical hysterectomy, and how to account for the morcellation.

Currently, no code exists for laparoscopic supracervical hysterectomy. Your proposed choice, 58550-52 (laparoscopy surgical; with vaginal hysterectomy for uterus 250 grams or less; reduced service), is sometimes used, but payers just as frequently accept unlisted code 58578 (unlisted laparoscopy procedure, uterus). The latter option, with documentation, sometimes results in prompter and fairer reimbursement over the -52 modifier option. The reason: The procedure is more completely described via the submitted documentation, and payers are less likely to reduce their allowable, even though the cervix was left in place.

When morcellation of the uterus is performed, however, the situation changes: This technique is performed to shred and extract a very large uterus, and CPT has a code (58553) for laparoscopic vaginal hysterectomy for a uterus weighing more than 250 g. Thus, your options would be to bill either 58553-52 or the unlisted code 58578.

Q My physician performed a laparoscopic supracervical hysterectomy with morcellation. Would I bill 58550-52?

A This question has 2 parts: how to bill for a laparoscopic supracervical hysterectomy, and how to account for the morcellation.

Currently, no code exists for laparoscopic supracervical hysterectomy. Your proposed choice, 58550-52 (laparoscopy surgical; with vaginal hysterectomy for uterus 250 grams or less; reduced service), is sometimes used, but payers just as frequently accept unlisted code 58578 (unlisted laparoscopy procedure, uterus). The latter option, with documentation, sometimes results in prompter and fairer reimbursement over the -52 modifier option. The reason: The procedure is more completely described via the submitted documentation, and payers are less likely to reduce their allowable, even though the cervix was left in place.

When morcellation of the uterus is performed, however, the situation changes: This technique is performed to shred and extract a very large uterus, and CPT has a code (58553) for laparoscopic vaginal hysterectomy for a uterus weighing more than 250 g. Thus, your options would be to bill either 58553-52 or the unlisted code 58578.

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Did failure to note calcifications delay breast cancer diagnosis?

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Did failure to note calcifications delay breast cancer diagnosis?

Lavaca County (Tex) District Court

Twenty-two months after undergoing a mammogram that was reported as normal, a woman in her forties detected a mass in her breast. A biopsy confirmed stage II breast cancer.

In suing, the woman claimed that the radiologist who read her mammogram was negligent for not identifying suspicious calcifications or recommending further evaluation. She argued that the delay in diagnosis allowed the malignancy to advance, thus lowering her life expectancy and making lymph node dissection, chemotherapy, and radiation necessary.

The physician argued that the mass was not visible in the mammogram and that the delay did not have a significant effect on her life expectancy.

  • The case settled for $300,000.
The cases presented here were compiled by Lewis L. Laska, editor of Medical Malpractice Verdicts, Settlements & Experts (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.
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Lavaca County (Tex) District Court

Twenty-two months after undergoing a mammogram that was reported as normal, a woman in her forties detected a mass in her breast. A biopsy confirmed stage II breast cancer.

In suing, the woman claimed that the radiologist who read her mammogram was negligent for not identifying suspicious calcifications or recommending further evaluation. She argued that the delay in diagnosis allowed the malignancy to advance, thus lowering her life expectancy and making lymph node dissection, chemotherapy, and radiation necessary.

The physician argued that the mass was not visible in the mammogram and that the delay did not have a significant effect on her life expectancy.

  • The case settled for $300,000.
The cases presented here were compiled by Lewis L. Laska, editor of Medical Malpractice Verdicts, Settlements & Experts (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.

Lavaca County (Tex) District Court

Twenty-two months after undergoing a mammogram that was reported as normal, a woman in her forties detected a mass in her breast. A biopsy confirmed stage II breast cancer.

In suing, the woman claimed that the radiologist who read her mammogram was negligent for not identifying suspicious calcifications or recommending further evaluation. She argued that the delay in diagnosis allowed the malignancy to advance, thus lowering her life expectancy and making lymph node dissection, chemotherapy, and radiation necessary.

The physician argued that the mass was not visible in the mammogram and that the delay did not have a significant effect on her life expectancy.

  • The case settled for $300,000.
The cases presented here were compiled by Lewis L. Laska, editor of Medical Malpractice Verdicts, Settlements & Experts (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.
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Did injury at cystectomy lead to need for dialysis?

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Did injury at cystectomy lead to need for dialysis?

District of Columbia Superior Court

While removing a large cyst from a 46-year-old diabetic woman, a physician feared he may have cut or ligated the patient’s right ureter. Based on an indigo carmine dye test, however, he determined the ureter remained undamaged.

In the days following the procedure, the patient began to experience back pain, blood in the urine, nausea, fever, elevated creatinine, and other signs of ureteral damage. The physician, however, waited 8 days before consulting with a urologist, who concluded the patient had an obstruction of the right ureter.

Surgery 4 days later revealed the injury was beyond repair, and the patient’s right ureter and right kidney were removed. In the following months, the woman’s overall kidney function declined sharply, and she was ultimately placed on dialysis.

In suing, the woman claimed her physician did not properly assess the status, location, and integrity of the right ureter, and did not appropriately address her postoperative symptoms. She further claimed that the injury accelerated her need for dialysis and thus shortened her life expectancy by 6 to 7 years.

The doctor argued that he did not violate the standard of care, and that the woman’s preexisting renal condition, not the injury, created the need for dialysis. He maintained that the patient’s noncompliance with previous recommendations and a lack of more aggressive medical treatment were also, in part, to blame for the injury.

  • The case settled for $3 million.
The cases presented here were compiled by Lewis L. Laska, editor of Medical Malpractice Verdicts, Settlements & Experts (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.
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District of Columbia Superior Court

While removing a large cyst from a 46-year-old diabetic woman, a physician feared he may have cut or ligated the patient’s right ureter. Based on an indigo carmine dye test, however, he determined the ureter remained undamaged.

In the days following the procedure, the patient began to experience back pain, blood in the urine, nausea, fever, elevated creatinine, and other signs of ureteral damage. The physician, however, waited 8 days before consulting with a urologist, who concluded the patient had an obstruction of the right ureter.

Surgery 4 days later revealed the injury was beyond repair, and the patient’s right ureter and right kidney were removed. In the following months, the woman’s overall kidney function declined sharply, and she was ultimately placed on dialysis.

In suing, the woman claimed her physician did not properly assess the status, location, and integrity of the right ureter, and did not appropriately address her postoperative symptoms. She further claimed that the injury accelerated her need for dialysis and thus shortened her life expectancy by 6 to 7 years.

The doctor argued that he did not violate the standard of care, and that the woman’s preexisting renal condition, not the injury, created the need for dialysis. He maintained that the patient’s noncompliance with previous recommendations and a lack of more aggressive medical treatment were also, in part, to blame for the injury.

  • The case settled for $3 million.
The cases presented here were compiled by Lewis L. Laska, editor of Medical Malpractice Verdicts, Settlements & Experts (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.

District of Columbia Superior Court

While removing a large cyst from a 46-year-old diabetic woman, a physician feared he may have cut or ligated the patient’s right ureter. Based on an indigo carmine dye test, however, he determined the ureter remained undamaged.

In the days following the procedure, the patient began to experience back pain, blood in the urine, nausea, fever, elevated creatinine, and other signs of ureteral damage. The physician, however, waited 8 days before consulting with a urologist, who concluded the patient had an obstruction of the right ureter.

Surgery 4 days later revealed the injury was beyond repair, and the patient’s right ureter and right kidney were removed. In the following months, the woman’s overall kidney function declined sharply, and she was ultimately placed on dialysis.

In suing, the woman claimed her physician did not properly assess the status, location, and integrity of the right ureter, and did not appropriately address her postoperative symptoms. She further claimed that the injury accelerated her need for dialysis and thus shortened her life expectancy by 6 to 7 years.

The doctor argued that he did not violate the standard of care, and that the woman’s preexisting renal condition, not the injury, created the need for dialysis. He maintained that the patient’s noncompliance with previous recommendations and a lack of more aggressive medical treatment were also, in part, to blame for the injury.

  • The case settled for $3 million.
The cases presented here were compiled by Lewis L. Laska, editor of Medical Malpractice Verdicts, Settlements & Experts (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.
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Towel left in abdomen found 8 years later

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US District Court (Utah) District of Utah

After undergoing a total abdominal hysterectomy, a woman in her thirties noted feeling bloated and unwell. She was told these symptoms were not uncommon and was discharged 5 days later.

Eight years following the surgery, a surgical towel was discovered in her abdomen. It was surgically removed.

In suing, the woman alleged that the doctor and staff involved with the hysterectomy were negligent in using a towel without a radio-opaque marker. She further argued that the clinicians did not properly count the materials used in the procedure.

The doctor denied responsibility, claiming that the nurses or technicians were responsible for accounting for all towels. The defendants also alleged that the towel may have been left in her abdomen during earlier cesarean sections, and noted that any injuries stemming from the towel were unlikely to be serious.

  • The case against the hospital settled for $150,000. The claim against the doctor went to trial; a jury found the hospital personnel responsible. The plaintiff has appealed the verdict.
The cases presented here were compiled by Lewis L. Laska, editor of Medical Malpractice Verdicts, Settlements & Experts (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.
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US District Court (Utah) District of Utah

After undergoing a total abdominal hysterectomy, a woman in her thirties noted feeling bloated and unwell. She was told these symptoms were not uncommon and was discharged 5 days later.

Eight years following the surgery, a surgical towel was discovered in her abdomen. It was surgically removed.

In suing, the woman alleged that the doctor and staff involved with the hysterectomy were negligent in using a towel without a radio-opaque marker. She further argued that the clinicians did not properly count the materials used in the procedure.

The doctor denied responsibility, claiming that the nurses or technicians were responsible for accounting for all towels. The defendants also alleged that the towel may have been left in her abdomen during earlier cesarean sections, and noted that any injuries stemming from the towel were unlikely to be serious.

  • The case against the hospital settled for $150,000. The claim against the doctor went to trial; a jury found the hospital personnel responsible. The plaintiff has appealed the verdict.
The cases presented here were compiled by Lewis L. Laska, editor of Medical Malpractice Verdicts, Settlements & Experts (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.

US District Court (Utah) District of Utah

After undergoing a total abdominal hysterectomy, a woman in her thirties noted feeling bloated and unwell. She was told these symptoms were not uncommon and was discharged 5 days later.

Eight years following the surgery, a surgical towel was discovered in her abdomen. It was surgically removed.

In suing, the woman alleged that the doctor and staff involved with the hysterectomy were negligent in using a towel without a radio-opaque marker. She further argued that the clinicians did not properly count the materials used in the procedure.

The doctor denied responsibility, claiming that the nurses or technicians were responsible for accounting for all towels. The defendants also alleged that the towel may have been left in her abdomen during earlier cesarean sections, and noted that any injuries stemming from the towel were unlikely to be serious.

  • The case against the hospital settled for $150,000. The claim against the doctor went to trial; a jury found the hospital personnel responsible. The plaintiff has appealed the verdict.
The cases presented here were compiled by Lewis L. Laska, editor of Medical Malpractice Verdicts, Settlements & Experts (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.
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Did misuse of forceps cause dyspareunia?

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Did misuse of forceps cause dyspareunia?

Miami-Dade County (Fla) Circuit Court

The day after delivering a healthy baby boy with the assistance of forceps, a 28-year-old woman complained of severe vulvar pain. Her physician assured her that vaginal swelling and bruising were common following forceps delivery. A few weeks later, the woman was seen by the physician’s partner, who observed the injury and referred the patient for further treatment. She was ultimately diagnosed with pudendal nerve damage, and underwent a variety of pain-control procedures by a number of different physicians.

The plaintiff alleged that misuse and misapplication of the forceps caused her injury, which has led to chronic vulvar pain and dyspareunia.

The defendants maintained that the delivery was carried out appropriately, and claimed the woman’s injury was due to the child moving through the birth canal, not to the forceps.

  • The jury returned a defense verdict.
The cases presented here were compiled by Lewis L. Laska, editor of Medical Malpractice Verdicts, Settlements & Experts (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.
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Miami-Dade County (Fla) Circuit Court

The day after delivering a healthy baby boy with the assistance of forceps, a 28-year-old woman complained of severe vulvar pain. Her physician assured her that vaginal swelling and bruising were common following forceps delivery. A few weeks later, the woman was seen by the physician’s partner, who observed the injury and referred the patient for further treatment. She was ultimately diagnosed with pudendal nerve damage, and underwent a variety of pain-control procedures by a number of different physicians.

The plaintiff alleged that misuse and misapplication of the forceps caused her injury, which has led to chronic vulvar pain and dyspareunia.

The defendants maintained that the delivery was carried out appropriately, and claimed the woman’s injury was due to the child moving through the birth canal, not to the forceps.

  • The jury returned a defense verdict.
The cases presented here were compiled by Lewis L. Laska, editor of Medical Malpractice Verdicts, Settlements & Experts (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.

Miami-Dade County (Fla) Circuit Court

The day after delivering a healthy baby boy with the assistance of forceps, a 28-year-old woman complained of severe vulvar pain. Her physician assured her that vaginal swelling and bruising were common following forceps delivery. A few weeks later, the woman was seen by the physician’s partner, who observed the injury and referred the patient for further treatment. She was ultimately diagnosed with pudendal nerve damage, and underwent a variety of pain-control procedures by a number of different physicians.

The plaintiff alleged that misuse and misapplication of the forceps caused her injury, which has led to chronic vulvar pain and dyspareunia.

The defendants maintained that the delivery was carried out appropriately, and claimed the woman’s injury was due to the child moving through the birth canal, not to the forceps.

  • The jury returned a defense verdict.
The cases presented here were compiled by Lewis L. Laska, editor of Medical Malpractice Verdicts, Settlements & Experts (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.
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Erb’s palsy, neurologic problems follow ‘traumatic delivery’

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Kings County (NY) Supreme Court

Following 3 days of irregular labor pains, a woman at 42 weeks’ gestation underwent labor induction. Thirteen hours after initiating the induction, the doctor recorded that the patient was fully dilated.

The physician noted shoulder dystocia after the mother had been pushing for 3 hours. After numerous attempts to extricate the shoulder proved unsuccessful, various staff members applied suprapubic pressure while the physician attempted to deliver the infant.

Upon delivery, the child was limp and flaccid; exhibited no respiration or reflexes; had an abnormal heart rate; and suffered a fractured right humerus, swelling, bruising, and abrasions on his face and head. The medical note indicated “a prolonged labor and a traumatic delivery.” The child now suffers from left Erb’s palsy, as well as cognitive, language, and attention problems.

The plaintiffs alleged the doctor should have opted for a cesarean delivery, and contended that he administered too much oxytocin during induction and used excessive force at delivery. In addition, they argued that the hospital attempted to cover up the events of the delivery, noting that the final 4 hours of fetal heart rate tracings and the last 90 minutes of labor progress notes were missing from the hospital chart.

The defendants maintained that a trial of labor was appropriate, and that the brachial plexus injury stemmed from the dystocia, not excessive force. They also argued the child did not suffer brain damage at the time of delivery.

  • The jury awarded the plaintiffs $2.5 million against the physician. The hospital was found not liable.
The cases presented here were compiled by Lewis L. Laska, editor of Medical Malpractice Verdicts, Settlements & Experts (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.
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Kings County (NY) Supreme Court

Following 3 days of irregular labor pains, a woman at 42 weeks’ gestation underwent labor induction. Thirteen hours after initiating the induction, the doctor recorded that the patient was fully dilated.

The physician noted shoulder dystocia after the mother had been pushing for 3 hours. After numerous attempts to extricate the shoulder proved unsuccessful, various staff members applied suprapubic pressure while the physician attempted to deliver the infant.

Upon delivery, the child was limp and flaccid; exhibited no respiration or reflexes; had an abnormal heart rate; and suffered a fractured right humerus, swelling, bruising, and abrasions on his face and head. The medical note indicated “a prolonged labor and a traumatic delivery.” The child now suffers from left Erb’s palsy, as well as cognitive, language, and attention problems.

The plaintiffs alleged the doctor should have opted for a cesarean delivery, and contended that he administered too much oxytocin during induction and used excessive force at delivery. In addition, they argued that the hospital attempted to cover up the events of the delivery, noting that the final 4 hours of fetal heart rate tracings and the last 90 minutes of labor progress notes were missing from the hospital chart.

The defendants maintained that a trial of labor was appropriate, and that the brachial plexus injury stemmed from the dystocia, not excessive force. They also argued the child did not suffer brain damage at the time of delivery.

  • The jury awarded the plaintiffs $2.5 million against the physician. The hospital was found not liable.
The cases presented here were compiled by Lewis L. Laska, editor of Medical Malpractice Verdicts, Settlements & Experts (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.

Kings County (NY) Supreme Court

Following 3 days of irregular labor pains, a woman at 42 weeks’ gestation underwent labor induction. Thirteen hours after initiating the induction, the doctor recorded that the patient was fully dilated.

The physician noted shoulder dystocia after the mother had been pushing for 3 hours. After numerous attempts to extricate the shoulder proved unsuccessful, various staff members applied suprapubic pressure while the physician attempted to deliver the infant.

Upon delivery, the child was limp and flaccid; exhibited no respiration or reflexes; had an abnormal heart rate; and suffered a fractured right humerus, swelling, bruising, and abrasions on his face and head. The medical note indicated “a prolonged labor and a traumatic delivery.” The child now suffers from left Erb’s palsy, as well as cognitive, language, and attention problems.

The plaintiffs alleged the doctor should have opted for a cesarean delivery, and contended that he administered too much oxytocin during induction and used excessive force at delivery. In addition, they argued that the hospital attempted to cover up the events of the delivery, noting that the final 4 hours of fetal heart rate tracings and the last 90 minutes of labor progress notes were missing from the hospital chart.

The defendants maintained that a trial of labor was appropriate, and that the brachial plexus injury stemmed from the dystocia, not excessive force. They also argued the child did not suffer brain damage at the time of delivery.

  • The jury awarded the plaintiffs $2.5 million against the physician. The hospital was found not liable.
The cases presented here were compiled by Lewis L. Laska, editor of Medical Malpractice Verdicts, Settlements & Experts (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.
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Was doctor negligent in episiotomy repair?

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Jackson County (Mo) Circuit Court

An episiotomy performed on a 28-year-old woman during delivery extended into a perineal laceration. Five days following the delivery, the repair broke, causing the woman fecal and gas incontinence. She required follow-up surgery 7 months later to repair the damage.

The woman alleged the doctor was negligent in the repair, and that as a result of this negligence 2 subsequent pregnancies had to be delivered by cesarean.

The physician contended that her injury was a known risk of the procedure. In addition, he suggested the broken repair was caused by factors other than the quality of his repair at birth.

  • The jury returned a defense verdict.
The cases presented here were compiled by Lewis L. Laska, editor of Medical Malpractice Verdicts, Settlements & Experts (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.
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Jackson County (Mo) Circuit Court

An episiotomy performed on a 28-year-old woman during delivery extended into a perineal laceration. Five days following the delivery, the repair broke, causing the woman fecal and gas incontinence. She required follow-up surgery 7 months later to repair the damage.

The woman alleged the doctor was negligent in the repair, and that as a result of this negligence 2 subsequent pregnancies had to be delivered by cesarean.

The physician contended that her injury was a known risk of the procedure. In addition, he suggested the broken repair was caused by factors other than the quality of his repair at birth.

  • The jury returned a defense verdict.
The cases presented here were compiled by Lewis L. Laska, editor of Medical Malpractice Verdicts, Settlements & Experts (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.

Jackson County (Mo) Circuit Court

An episiotomy performed on a 28-year-old woman during delivery extended into a perineal laceration. Five days following the delivery, the repair broke, causing the woman fecal and gas incontinence. She required follow-up surgery 7 months later to repair the damage.

The woman alleged the doctor was negligent in the repair, and that as a result of this negligence 2 subsequent pregnancies had to be delivered by cesarean.

The physician contended that her injury was a known risk of the procedure. In addition, he suggested the broken repair was caused by factors other than the quality of his repair at birth.

  • The jury returned a defense verdict.
The cases presented here were compiled by Lewis L. Laska, editor of Medical Malpractice Verdicts, Settlements & Experts (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.
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