User login
Premature delivery results in retinopathy, blindness
A woman at 27 weeks’ gestation delivered twins. Because they were premature, the newborns were placed in oxygen tents. While one infant experienced no problems, the other developed retinopathy resulting in blindness.
In suing, the mother claimed that the neonates were not properly monitored. She further argued that the infants were never examined by an ophthalmologist.
Hospital staff contended that retinopathy is a known risk factor in premature deliveries.
- The case settled for $2.5 million.
A woman at 27 weeks’ gestation delivered twins. Because they were premature, the newborns were placed in oxygen tents. While one infant experienced no problems, the other developed retinopathy resulting in blindness.
In suing, the mother claimed that the neonates were not properly monitored. She further argued that the infants were never examined by an ophthalmologist.
Hospital staff contended that retinopathy is a known risk factor in premature deliveries.
- The case settled for $2.5 million.
A woman at 27 weeks’ gestation delivered twins. Because they were premature, the newborns were placed in oxygen tents. While one infant experienced no problems, the other developed retinopathy resulting in blindness.
In suing, the mother claimed that the neonates were not properly monitored. She further argued that the infants were never examined by an ophthalmologist.
Hospital staff contended that retinopathy is a known risk factor in premature deliveries.
- The case settled for $2.5 million.
Artery, vein, bowel lacerations complicate oophorectomy
A 25-year-old woman presented to a hospital for removal of an ovary. During the procedure, the physician had difficulty grasping the ovary and utilized a trocar. The instrument’s placement resulted in laceration of the patient’s iliac artery, vein, and bowel.
Following surgery, the patient remained in the hospital for 12 days, 3 days of which were spent on life support. Postoperatively, the patient developed clotting and continues to take blood-thinning medication.
In suing, the woman claimed that the doctor did not position himself at a proper angle to perform the surgery and failed to avoid blood vessels.
The doctor argued that the patient’s injury was due to a faulty trocar, noting that the shield fell off during surgery.
- The jury awarded the plaintiff $620,000.
A 25-year-old woman presented to a hospital for removal of an ovary. During the procedure, the physician had difficulty grasping the ovary and utilized a trocar. The instrument’s placement resulted in laceration of the patient’s iliac artery, vein, and bowel.
Following surgery, the patient remained in the hospital for 12 days, 3 days of which were spent on life support. Postoperatively, the patient developed clotting and continues to take blood-thinning medication.
In suing, the woman claimed that the doctor did not position himself at a proper angle to perform the surgery and failed to avoid blood vessels.
The doctor argued that the patient’s injury was due to a faulty trocar, noting that the shield fell off during surgery.
- The jury awarded the plaintiff $620,000.
A 25-year-old woman presented to a hospital for removal of an ovary. During the procedure, the physician had difficulty grasping the ovary and utilized a trocar. The instrument’s placement resulted in laceration of the patient’s iliac artery, vein, and bowel.
Following surgery, the patient remained in the hospital for 12 days, 3 days of which were spent on life support. Postoperatively, the patient developed clotting and continues to take blood-thinning medication.
In suing, the woman claimed that the doctor did not position himself at a proper angle to perform the surgery and failed to avoid blood vessels.
The doctor argued that the patient’s injury was due to a faulty trocar, noting that the shield fell off during surgery.
- The jury awarded the plaintiff $620,000.
Meningitis follows maternal infection
<court>Cook County (Ill) Circuit Court</court>
During pregnancy, a woman experienced a urinary tract infection with group B streptococcus. Twenty-four hours after delivery, her infant son developed meningitis and group B streptococcus sepsis. The plaintiff, who was 12 at the time of the trial, suffers from attention deficit hyperactivity disorder and learning disabilities.
In suing, the plaintiff argued that given his mother’s infection during pregnancy, she should have received prophylactic antibiotics during labor or he should have been given antibiotics following birth.
The doctor argued that in 1990, when the incident occurred, there were no standards for administering intrapartum antibiotics under these circumstances.
- The jury returned defense verdicts for the obstetrician and pediatrician; the plaintiff settled with the hospital and nurse for $2.75 million.
The cases presented here were compiled by Lewis L. Laska, editor of Medical Malpractice Verdicts, Settlements & Experts. While there are instances when the available information is incomplete, these cases represent the types of clinical situations that typically result in litigation.
<court>Cook County (Ill) Circuit Court</court>
During pregnancy, a woman experienced a urinary tract infection with group B streptococcus. Twenty-four hours after delivery, her infant son developed meningitis and group B streptococcus sepsis. The plaintiff, who was 12 at the time of the trial, suffers from attention deficit hyperactivity disorder and learning disabilities.
In suing, the plaintiff argued that given his mother’s infection during pregnancy, she should have received prophylactic antibiotics during labor or he should have been given antibiotics following birth.
The doctor argued that in 1990, when the incident occurred, there were no standards for administering intrapartum antibiotics under these circumstances.
- The jury returned defense verdicts for the obstetrician and pediatrician; the plaintiff settled with the hospital and nurse for $2.75 million.
The cases presented here were compiled by Lewis L. Laska, editor of Medical Malpractice Verdicts, Settlements & Experts. While there are instances when the available information is incomplete, these cases represent the types of clinical situations that typically result in litigation.
<court>Cook County (Ill) Circuit Court</court>
During pregnancy, a woman experienced a urinary tract infection with group B streptococcus. Twenty-four hours after delivery, her infant son developed meningitis and group B streptococcus sepsis. The plaintiff, who was 12 at the time of the trial, suffers from attention deficit hyperactivity disorder and learning disabilities.
In suing, the plaintiff argued that given his mother’s infection during pregnancy, she should have received prophylactic antibiotics during labor or he should have been given antibiotics following birth.
The doctor argued that in 1990, when the incident occurred, there were no standards for administering intrapartum antibiotics under these circumstances.
- The jury returned defense verdicts for the obstetrician and pediatrician; the plaintiff settled with the hospital and nurse for $2.75 million.
The cases presented here were compiled by Lewis L. Laska, editor of Medical Malpractice Verdicts, Settlements & Experts. While there are instances when the available information is incomplete, these cases represent the types of clinical situations that typically result in litigation.
Death blamed on failure to treat preeclampsia
Following delivery of a healthy baby, a 29-year-old woman began experiencing various problems, including rib pain, flu-like symptoms, and “sparkles” in her field of vision. Later, she developed adult respiratory distress syndrome and was admitted to intensive care. One month after giving birth, she died of multiorgan failure.
In suing, the husband claimed that the doctor failed to detect and treat severe preeclampsia and/or hemolysis, elevated liver enzymes, and low platelet count syndrome.
The doctor argued his quality of care was adequate. He also noted that severe preeclampsia has a high mortality rate, regardless of the care, and is often resolved postdelivery.
- The jury returned a verdict for the defense.
Following delivery of a healthy baby, a 29-year-old woman began experiencing various problems, including rib pain, flu-like symptoms, and “sparkles” in her field of vision. Later, she developed adult respiratory distress syndrome and was admitted to intensive care. One month after giving birth, she died of multiorgan failure.
In suing, the husband claimed that the doctor failed to detect and treat severe preeclampsia and/or hemolysis, elevated liver enzymes, and low platelet count syndrome.
The doctor argued his quality of care was adequate. He also noted that severe preeclampsia has a high mortality rate, regardless of the care, and is often resolved postdelivery.
- The jury returned a verdict for the defense.
Following delivery of a healthy baby, a 29-year-old woman began experiencing various problems, including rib pain, flu-like symptoms, and “sparkles” in her field of vision. Later, she developed adult respiratory distress syndrome and was admitted to intensive care. One month after giving birth, she died of multiorgan failure.
In suing, the husband claimed that the doctor failed to detect and treat severe preeclampsia and/or hemolysis, elevated liver enzymes, and low platelet count syndrome.
The doctor argued his quality of care was adequate. He also noted that severe preeclampsia has a high mortality rate, regardless of the care, and is often resolved postdelivery.
- The jury returned a verdict for the defense.
Did air embolism during hysterectomy lead to death?
While undergoing a hysterectomy, a 48-year-old woman experienced a cardiopulmonary collapse. She subsequently died, despite resuscitation efforts.
The family sued, arguing that the cardiac emergency resulted from air traveling through the intravenous tubing controlled by the defendant anesthesiologist. They also maintained that the defendant failed to turn off the gas and administer epinephrine to the patient during the resuscitation efforts.
The doctor claimed that the patient died of unknown causes and that the autopsy was inconclusive.
- The jury awarded the plaintiff $1.5 million.
While undergoing a hysterectomy, a 48-year-old woman experienced a cardiopulmonary collapse. She subsequently died, despite resuscitation efforts.
The family sued, arguing that the cardiac emergency resulted from air traveling through the intravenous tubing controlled by the defendant anesthesiologist. They also maintained that the defendant failed to turn off the gas and administer epinephrine to the patient during the resuscitation efforts.
The doctor claimed that the patient died of unknown causes and that the autopsy was inconclusive.
- The jury awarded the plaintiff $1.5 million.
While undergoing a hysterectomy, a 48-year-old woman experienced a cardiopulmonary collapse. She subsequently died, despite resuscitation efforts.
The family sued, arguing that the cardiac emergency resulted from air traveling through the intravenous tubing controlled by the defendant anesthesiologist. They also maintained that the defendant failed to turn off the gas and administer epinephrine to the patient during the resuscitation efforts.
The doctor claimed that the patient died of unknown causes and that the autopsy was inconclusive.
- The jury awarded the plaintiff $1.5 million.
Infant’s cerebral palsy follows maternal hemorrhage
A pregnant woman near term presented to a hospital with severe vaginal bleeding. She had undergone a previous cesarean delivery. The patient was examined by a nurse midwife who was in contact with an obstetrician. The following evening, the infant was delivered via cesarean section with brain damage and subsequent cerebral palsy.
In suing, the parents alleged that the doctor should have examined the mother upon admission. They argued that their son suffered profound brain damage due to inadequate oxygenation prior to delivery.
Both the nurse midwife and obstetrician maintained that their management was well within the standard of care. Further, the doctor claimed that a knot in the umbilical cord could have caused a lack of proper oxygen to the fetus.
- The jury awarded the plaintiffs $12 million.
A pregnant woman near term presented to a hospital with severe vaginal bleeding. She had undergone a previous cesarean delivery. The patient was examined by a nurse midwife who was in contact with an obstetrician. The following evening, the infant was delivered via cesarean section with brain damage and subsequent cerebral palsy.
In suing, the parents alleged that the doctor should have examined the mother upon admission. They argued that their son suffered profound brain damage due to inadequate oxygenation prior to delivery.
Both the nurse midwife and obstetrician maintained that their management was well within the standard of care. Further, the doctor claimed that a knot in the umbilical cord could have caused a lack of proper oxygen to the fetus.
- The jury awarded the plaintiffs $12 million.
A pregnant woman near term presented to a hospital with severe vaginal bleeding. She had undergone a previous cesarean delivery. The patient was examined by a nurse midwife who was in contact with an obstetrician. The following evening, the infant was delivered via cesarean section with brain damage and subsequent cerebral palsy.
In suing, the parents alleged that the doctor should have examined the mother upon admission. They argued that their son suffered profound brain damage due to inadequate oxygenation prior to delivery.
Both the nurse midwife and obstetrician maintained that their management was well within the standard of care. Further, the doctor claimed that a knot in the umbilical cord could have caused a lack of proper oxygen to the fetus.
- The jury awarded the plaintiffs $12 million.
Modifiers needed for endometrial cryoablation?
So long as the physician supervised the procedure, I would bill the code with no modifiers attached. The hospital can bill separately for the use of the machine and the hospital tech.
So long as the physician supervised the procedure, I would bill the code with no modifiers attached. The hospital can bill separately for the use of the machine and the hospital tech.
So long as the physician supervised the procedure, I would bill the code with no modifiers attached. The hospital can bill separately for the use of the machine and the hospital tech.
Billing for the ultrasound technician
- a professional component, which consists of the physician’s interpretation of the results and his or her written report, and
- a technical component, consisting of the machine and supplies as well as the sonographer who performs the scan.
Therefore, when the ultrasound is performed in your office on your own equipment, you always bill the code under the physician’s number, without a modifier.
- a professional component, which consists of the physician’s interpretation of the results and his or her written report, and
- a technical component, consisting of the machine and supplies as well as the sonographer who performs the scan.
Therefore, when the ultrasound is performed in your office on your own equipment, you always bill the code under the physician’s number, without a modifier.
- a professional component, which consists of the physician’s interpretation of the results and his or her written report, and
- a technical component, consisting of the machine and supplies as well as the sonographer who performs the scan.
Therefore, when the ultrasound is performed in your office on your own equipment, you always bill the code under the physician’s number, without a modifier.
Postdelivery laceration repair, blood evacuation
If the laceration repair was done at the time of delivery, add modifier -51 (multiple procedure) to the repair code; if the patient was brought back to the operating room for the procedure, use modifier -78 (return to operating room for a related procedure during the postoperative period). Alternatively, you might consider adding modifier -22 (unusual services) to the delivery code for the documented significant additional work involved with the repair.
As for the return to the operating room for blood evacuation: You cannot use 49020, as that code is for draining a peritoneal abscess. Code 49002 (reopening of recent laparotomy) would also be incorrect, unless the delivery was by cesarean. For vaginal delivery, I would use either 49000 (exploratory laparotomy, exploratory celiotomy with or without biopsy[s] [separate procedure]) or 35840 (exploration for postoperative hemorrhage, thrombosis or infection; abdomen).
Note that I could find no CPT reference regarding the intended use of code 35840 as opposed to 49000. However, 35840 is located in CPT’s cardiovascular-system section; this may influence a payer as to acceptable linking diagnoses. The short descriptors for these 2 codes differ slightly: Code 35840 says “exploration of abdominal vessels” while 49000 reads “exploration of abdomen.” Code 35840, by the way, has fewer relative value units than 49000.
If the laceration repair was done at the time of delivery, add modifier -51 (multiple procedure) to the repair code; if the patient was brought back to the operating room for the procedure, use modifier -78 (return to operating room for a related procedure during the postoperative period). Alternatively, you might consider adding modifier -22 (unusual services) to the delivery code for the documented significant additional work involved with the repair.
As for the return to the operating room for blood evacuation: You cannot use 49020, as that code is for draining a peritoneal abscess. Code 49002 (reopening of recent laparotomy) would also be incorrect, unless the delivery was by cesarean. For vaginal delivery, I would use either 49000 (exploratory laparotomy, exploratory celiotomy with or without biopsy[s] [separate procedure]) or 35840 (exploration for postoperative hemorrhage, thrombosis or infection; abdomen).
Note that I could find no CPT reference regarding the intended use of code 35840 as opposed to 49000. However, 35840 is located in CPT’s cardiovascular-system section; this may influence a payer as to acceptable linking diagnoses. The short descriptors for these 2 codes differ slightly: Code 35840 says “exploration of abdominal vessels” while 49000 reads “exploration of abdomen.” Code 35840, by the way, has fewer relative value units than 49000.
If the laceration repair was done at the time of delivery, add modifier -51 (multiple procedure) to the repair code; if the patient was brought back to the operating room for the procedure, use modifier -78 (return to operating room for a related procedure during the postoperative period). Alternatively, you might consider adding modifier -22 (unusual services) to the delivery code for the documented significant additional work involved with the repair.
As for the return to the operating room for blood evacuation: You cannot use 49020, as that code is for draining a peritoneal abscess. Code 49002 (reopening of recent laparotomy) would also be incorrect, unless the delivery was by cesarean. For vaginal delivery, I would use either 49000 (exploratory laparotomy, exploratory celiotomy with or without biopsy[s] [separate procedure]) or 35840 (exploration for postoperative hemorrhage, thrombosis or infection; abdomen).
Note that I could find no CPT reference regarding the intended use of code 35840 as opposed to 49000. However, 35840 is located in CPT’s cardiovascular-system section; this may influence a payer as to acceptable linking diagnoses. The short descriptors for these 2 codes differ slightly: Code 35840 says “exploration of abdominal vessels” while 49000 reads “exploration of abdomen.” Code 35840, by the way, has fewer relative value units than 49000.
Chemical cauterization of the cervix
If you think you can make a case for significant physician work in applying the silver nitrate, you can bill this as an unlisted procedure (58999). Otherwise, I would simply consider this incidental to the exam and bill only an evaluation and management service. You can, however, bill for the supplies using 99070 (supplies and materials [except spectacles], provided by the physician over and above those usually included with the office visit or other services rendered).
If you think you can make a case for significant physician work in applying the silver nitrate, you can bill this as an unlisted procedure (58999). Otherwise, I would simply consider this incidental to the exam and bill only an evaluation and management service. You can, however, bill for the supplies using 99070 (supplies and materials [except spectacles], provided by the physician over and above those usually included with the office visit or other services rendered).
If you think you can make a case for significant physician work in applying the silver nitrate, you can bill this as an unlisted procedure (58999). Otherwise, I would simply consider this incidental to the exam and bill only an evaluation and management service. You can, however, bill for the supplies using 99070 (supplies and materials [except spectacles], provided by the physician over and above those usually included with the office visit or other services rendered).