Managing Your Practice

Q Our physician performed colposcopy-directed vaginal biopsies and a transvaginal tape (TVT) procedure with cystoscopy. The diagnosis was a Pap result consistent with vaginal intraepithelial neoplasia I (VIN I). How should these procedures be coded?

A First, I hope there was another diagnosis besides VIN I—this condition justifies the directed biopsies but not the TVT procedure, which would be done for stress urinary incontinence (ICD-9-CM code 625.6).

For the TVT, the code you use will depend on the surgical approach. Use code 57288 for a vaginal approach or code 51992 for a laparoscopic approach. This sling procedure would be listed first on the claim, since it is the most extensive procedure.

Coding for the directed biopsies depends on whether your payer accepts the new CPT code for colposcopy with vaginal biopsy(s) (57421). If so, the claim should be submitted as 57288 or 51992 + 57421-51.

If your payer is still using the 2002 CPT codes, the only way to capture the colposcopy with vaginal biopsy would be to bill 2 codes: 57452 for the colposcopy plus either 57100 for a simple biopsy or 57105 for a biopsy that required suturing. Note that codes 57100 and 57452 are CPT “separate procedures” that are sometimes bundled together by the payer. For this reason, you’ll want to add modifier -59 (distinct procedure) to these codes. The result for these additional procedures: 57100-59-51 + 57452-59-51 or 57105-51 + 57452-59-51.

Some payers require modifier -51 (multiple procedure) be added when listing a second or third procedure, so their computer can handle the claim from a fee-reduction standpoint.

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-9CM coding. When in doubt on a coding or billing matter, check with your individual payer.

Q Our physician performed colposcopy-directed vaginal biopsies and a transvaginal tape (TVT) procedure with cystoscopy. The diagnosis was a Pap result consistent with vaginal intraepithelial neoplasia I (VIN I). How should these procedures be coded?

A First, I hope there was another diagnosis besides VIN I—this condition justifies the directed biopsies but not the TVT procedure, which would be done for stress urinary incontinence (ICD-9-CM code 625.6).

For the TVT, the code you use will depend on the surgical approach. Use code 57288 for a vaginal approach or code 51992 for a laparoscopic approach. This sling procedure would be listed first on the claim, since it is the most extensive procedure.

Coding for the directed biopsies depends on whether your payer accepts the new CPT code for colposcopy with vaginal biopsy(s) (57421). If so, the claim should be submitted as 57288 or 51992 + 57421-51.

If your payer is still using the 2002 CPT codes, the only way to capture the colposcopy with vaginal biopsy would be to bill 2 codes: 57452 for the colposcopy plus either 57100 for a simple biopsy or 57105 for a biopsy that required suturing. Note that codes 57100 and 57452 are CPT “separate procedures” that are sometimes bundled together by the payer. For this reason, you’ll want to add modifier -59 (distinct procedure) to these codes. The result for these additional procedures: 57100-59-51 + 57452-59-51 or 57105-51 + 57452-59-51.

Some payers require modifier -51 (multiple procedure) be added when listing a second or third procedure, so their computer can handle the claim from a fee-reduction standpoint.

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-9CM coding. When in doubt on a coding or billing matter, check with your individual payer.

Q Our physician performed colposcopy-directed vaginal biopsies and a transvaginal tape (TVT) procedure with cystoscopy. The diagnosis was a Pap result consistent with vaginal intraepithelial neoplasia I (VIN I). How should these procedures be coded?

A First, I hope there was another diagnosis besides VIN I—this condition justifies the directed biopsies but not the TVT procedure, which would be done for stress urinary incontinence (ICD-9-CM code 625.6).

For the TVT, the code you use will depend on the surgical approach. Use code 57288 for a vaginal approach or code 51992 for a laparoscopic approach. This sling procedure would be listed first on the claim, since it is the most extensive procedure.

Coding for the directed biopsies depends on whether your payer accepts the new CPT code for colposcopy with vaginal biopsy(s) (57421). If so, the claim should be submitted as 57288 or 51992 + 57421-51.

If your payer is still using the 2002 CPT codes, the only way to capture the colposcopy with vaginal biopsy would be to bill 2 codes: 57452 for the colposcopy plus either 57100 for a simple biopsy or 57105 for a biopsy that required suturing. Note that codes 57100 and 57452 are CPT “separate procedures” that are sometimes bundled together by the payer. For this reason, you’ll want to add modifier -59 (distinct procedure) to these codes. The result for these additional procedures: 57100-59-51 + 57452-59-51 or 57105-51 + 57452-59-51.

Some payers require modifier -51 (multiple procedure) be added when listing a second or third procedure, so their computer can handle the claim from a fee-reduction standpoint.

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-9CM coding. When in doubt on a coding or billing matter, check with your individual payer.

Q We recently had an obstetric patient who was admitted for observation due to upper-quadrant abdominal pain. During her stay, a general surgeon performed a cholecystectomy. She was discharged 6 days after admission, but immediately went into preterm labor, delivering at home at 27 weeks’ gestation. She and the baby were readmitted on the day after her discharge. How do I charge this?

A Did you provide all of the obstetric care except for the delivery? If so, you can bill the global obstetric service, should the payer allow, but should also add modifier -52 to indicate reduced services.

Alternatively, you may want to bill only for those services that were actually performed, by splitting the care into its component parts. This would mean billing for:

• the antepartum care using 59425 (4 to 6 visits) or 59426 (7 or more visits);
  
• the hospital admission after delivery (codes 99221-99223);
  
• the delivery of the placenta (code 59414) or an episiotomy (code 59300), if performed after the delivery; and
  
• the postpartum care (code 59430).
  

Note that the American College of Obstetricians and Gynecologists Coding Manual states that code 59430 includes both inpatient and outpatient postpartum care, but start until after delivery of the placenta. This means you can bill the hospital admission, but not the subsequent care or discharge home.

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-9CM coding. When in doubt on a coding or billing matter, check with your individual payer.

Q We recently had an obstetric patient who was admitted for observation due to upper-quadrant abdominal pain. During her stay, a general surgeon performed a cholecystectomy. She was discharged 6 days after admission, but immediately went into preterm labor, delivering at home at 27 weeks’ gestation. She and the baby were readmitted on the day after her discharge. How do I charge this?

A Did you provide all of the obstetric care except for the delivery? If so, you can bill the global obstetric service, should the payer allow, but should also add modifier -52 to indicate reduced services.

Alternatively, you may want to bill only for those services that were actually performed, by splitting the care into its component parts. This would mean billing for:

• the antepartum care using 59425 (4 to 6 visits) or 59426 (7 or more visits);
  
• the hospital admission after delivery (codes 99221-99223);
  
• the delivery of the placenta (code 59414) or an episiotomy (code 59300), if performed after the delivery; and
  
• the postpartum care (code 59430).
  

Note that the American College of Obstetricians and Gynecologists Coding Manual states that code 59430 includes both inpatient and outpatient postpartum care, but start until after delivery of the placenta. This means you can bill the hospital admission, but not the subsequent care or discharge home.

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-9CM coding. When in doubt on a coding or billing matter, check with your individual payer.

Q We recently had an obstetric patient who was admitted for observation due to upper-quadrant abdominal pain. During her stay, a general surgeon performed a cholecystectomy. She was discharged 6 days after admission, but immediately went into preterm labor, delivering at home at 27 weeks’ gestation. She and the baby were readmitted on the day after her discharge. How do I charge this?

A Did you provide all of the obstetric care except for the delivery? If so, you can bill the global obstetric service, should the payer allow, but should also add modifier -52 to indicate reduced services.

Alternatively, you may want to bill only for those services that were actually performed, by splitting the care into its component parts. This would mean billing for:

• the antepartum care using 59425 (4 to 6 visits) or 59426 (7 or more visits);
  
• the hospital admission after delivery (codes 99221-99223);
  
• the delivery of the placenta (code 59414) or an episiotomy (code 59300), if performed after the delivery; and
  
• the postpartum care (code 59430).
  

Note that the American College of Obstetricians and Gynecologists Coding Manual states that code 59430 includes both inpatient and outpatient postpartum care, but start until after delivery of the placenta. This means you can bill the hospital admission, but not the subsequent care or discharge home.

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-9CM coding. When in doubt on a coding or billing matter, check with your individual payer.

Q Our physician performed a laparoscopically assisted vaginal hysterectomy (LAVH) and McCall’s culdoplasty. What is the McCall’s, exactly, and can we bill for it?

A McCall’s culdoplasty is a vaginal-approach repair of an enterocele (CPT 57268) and is coded only if an enterocele was present and the sac removed.

In general, an enterocele is a peritoneal sac or space between the vagina and rectum that begins to prolapse after multiple pregnancies or after a long period of time due to gravity. When the enterocele causes pain and bulging, the surgeon will remove the sac during vaginal surgery. If documentation confirms the presence of the symptomatic enterocele, the payer will likely reimburse for it. Note, however, that you’ll have to add modifier -59 (distinct procedure) to 57268, since this is a CPT “separate procedure” that the payer normally bundles.

If the surgeon sews up the cul-de-sac at the time of the LAVH to prevent a future problem, it’s considered “tidying up” and preventive and, therefore, not separately billable.

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-9CM coding. When in doubt on a coding or billing matter, check with your individual payer.

Q Our physician performed a laparoscopically assisted vaginal hysterectomy (LAVH) and McCall’s culdoplasty. What is the McCall’s, exactly, and can we bill for it?

A McCall’s culdoplasty is a vaginal-approach repair of an enterocele (CPT 57268) and is coded only if an enterocele was present and the sac removed.

In general, an enterocele is a peritoneal sac or space between the vagina and rectum that begins to prolapse after multiple pregnancies or after a long period of time due to gravity. When the enterocele causes pain and bulging, the surgeon will remove the sac during vaginal surgery. If documentation confirms the presence of the symptomatic enterocele, the payer will likely reimburse for it. Note, however, that you’ll have to add modifier -59 (distinct procedure) to 57268, since this is a CPT “separate procedure” that the payer normally bundles.

If the surgeon sews up the cul-de-sac at the time of the LAVH to prevent a future problem, it’s considered “tidying up” and preventive and, therefore, not separately billable.

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-9CM coding. When in doubt on a coding or billing matter, check with your individual payer.

Q Our physician performed a laparoscopically assisted vaginal hysterectomy (LAVH) and McCall’s culdoplasty. What is the McCall’s, exactly, and can we bill for it?

A McCall’s culdoplasty is a vaginal-approach repair of an enterocele (CPT 57268) and is coded only if an enterocele was present and the sac removed.

In general, an enterocele is a peritoneal sac or space between the vagina and rectum that begins to prolapse after multiple pregnancies or after a long period of time due to gravity. When the enterocele causes pain and bulging, the surgeon will remove the sac during vaginal surgery. If documentation confirms the presence of the symptomatic enterocele, the payer will likely reimburse for it. Note, however, that you’ll have to add modifier -59 (distinct procedure) to 57268, since this is a CPT “separate procedure” that the payer normally bundles.

If the surgeon sews up the cul-de-sac at the time of the LAVH to prevent a future problem, it’s considered “tidying up” and preventive and, therefore, not separately billable.

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-9CM coding. When in doubt on a coding or billing matter, check with your individual payer.

Q Which CPT codes are recommended for low-risk and high-risk Medicare pelvic/breast exams for women aged 65 and older? Are the rules the same for non-Medicare third-party payers?

A For any screening pelvic/breast exam, Medicare requires that the alphanumeric Healthcare Common Procedure Coding System code (rather than a CPT preventive medicine code) you submit be linked to a specific ICD-9 code.

For the screening, you would report G0101 (cervical or vaginal cancer screening, pelvic and clinical breast examination), regardless of whether the patient is at low or high risk for cervical or vaginal cancer. Medicare only differentiates between the risk categories via the ICD-9 diagnostic code you use.

If the patient is at low risk, use ICD-9 code V76.2 (special screening for malignant neoplasms, cervix) or V76.49 (special screening for malignant neoplasms, other sites). Effective October 1, 2003, the code V76.47 (special screening for malignant neoplasms, vagina) may also be used. Note that V76.49 (and V76.47) is used only when the patient has had her uterus removed for reasons other than malignancy. If the patient is at high risk, the diagnosis changes to V15.89 (other specified personal history presenting hazards to health), along with a second code indicating which of Medicare’s 5 high-risk criteria applies. For a woman past childbearing age (which is all patients 65 or older), these criteria are:

• early onset of sexual activity (under 16 years of age) or multiple sexual partners (5 or more in a lifetime)—use V69.2, high-risk sexual behavior;
  
• history of a sexually transmitted disease (including HIV infection)—use V13.8, personal history of other diseases; V08, asymptomatic HIV; or 042, HIV infection;
  
• fewer than 3 negative Pap smears within the previous 7 years—use the diagnosis known at the time of the last Pap smear (if normal, use the code V13.2 for personal history of genitourinary disorder to indicate a previous abnormal Pap result); and
  
• diethylstilbestrol-exposed daughters of women who took the drug during pregnancy—use 760.76 (DES exposure).
  

Non-Medicare insurers have different rules: Unlike Medicare, they tend to pay for a comprehensive well-woman exam each year, billed using 1 of the CPT preventive medicine codes (99381 to 99397). The diagnostic coding is also different—specifically V72.3, gynecologic exam with Pap smear.

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-9CM coding. When in doubt on a coding or billing matter, check with your individual payer.

Q Which CPT codes are recommended for low-risk and high-risk Medicare pelvic/breast exams for women aged 65 and older? Are the rules the same for non-Medicare third-party payers?

A For any screening pelvic/breast exam, Medicare requires that the alphanumeric Healthcare Common Procedure Coding System code (rather than a CPT preventive medicine code) you submit be linked to a specific ICD-9 code.

For the screening, you would report G0101 (cervical or vaginal cancer screening, pelvic and clinical breast examination), regardless of whether the patient is at low or high risk for cervical or vaginal cancer. Medicare only differentiates between the risk categories via the ICD-9 diagnostic code you use.

If the patient is at low risk, use ICD-9 code V76.2 (special screening for malignant neoplasms, cervix) or V76.49 (special screening for malignant neoplasms, other sites). Effective October 1, 2003, the code V76.47 (special screening for malignant neoplasms, vagina) may also be used. Note that V76.49 (and V76.47) is used only when the patient has had her uterus removed for reasons other than malignancy. If the patient is at high risk, the diagnosis changes to V15.89 (other specified personal history presenting hazards to health), along with a second code indicating which of Medicare’s 5 high-risk criteria applies. For a woman past childbearing age (which is all patients 65 or older), these criteria are:

• early onset of sexual activity (under 16 years of age) or multiple sexual partners (5 or more in a lifetime)—use V69.2, high-risk sexual behavior;
  
• history of a sexually transmitted disease (including HIV infection)—use V13.8, personal history of other diseases; V08, asymptomatic HIV; or 042, HIV infection;
  
• fewer than 3 negative Pap smears within the previous 7 years—use the diagnosis known at the time of the last Pap smear (if normal, use the code V13.2 for personal history of genitourinary disorder to indicate a previous abnormal Pap result); and
  
• diethylstilbestrol-exposed daughters of women who took the drug during pregnancy—use 760.76 (DES exposure).
  

Non-Medicare insurers have different rules: Unlike Medicare, they tend to pay for a comprehensive well-woman exam each year, billed using 1 of the CPT preventive medicine codes (99381 to 99397). The diagnostic coding is also different—specifically V72.3, gynecologic exam with Pap smear.

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-9CM coding. When in doubt on a coding or billing matter, check with your individual payer.

Q Which CPT codes are recommended for low-risk and high-risk Medicare pelvic/breast exams for women aged 65 and older? Are the rules the same for non-Medicare third-party payers?

A For any screening pelvic/breast exam, Medicare requires that the alphanumeric Healthcare Common Procedure Coding System code (rather than a CPT preventive medicine code) you submit be linked to a specific ICD-9 code.

For the screening, you would report G0101 (cervical or vaginal cancer screening, pelvic and clinical breast examination), regardless of whether the patient is at low or high risk for cervical or vaginal cancer. Medicare only differentiates between the risk categories via the ICD-9 diagnostic code you use.

If the patient is at low risk, use ICD-9 code V76.2 (special screening for malignant neoplasms, cervix) or V76.49 (special screening for malignant neoplasms, other sites). Effective October 1, 2003, the code V76.47 (special screening for malignant neoplasms, vagina) may also be used. Note that V76.49 (and V76.47) is used only when the patient has had her uterus removed for reasons other than malignancy. If the patient is at high risk, the diagnosis changes to V15.89 (other specified personal history presenting hazards to health), along with a second code indicating which of Medicare’s 5 high-risk criteria applies. For a woman past childbearing age (which is all patients 65 or older), these criteria are:

• early onset of sexual activity (under 16 years of age) or multiple sexual partners (5 or more in a lifetime)—use V69.2, high-risk sexual behavior;
  
• history of a sexually transmitted disease (including HIV infection)—use V13.8, personal history of other diseases; V08, asymptomatic HIV; or 042, HIV infection;
  
• fewer than 3 negative Pap smears within the previous 7 years—use the diagnosis known at the time of the last Pap smear (if normal, use the code V13.2 for personal history of genitourinary disorder to indicate a previous abnormal Pap result); and
  
• diethylstilbestrol-exposed daughters of women who took the drug during pregnancy—use 760.76 (DES exposure).
  

Non-Medicare insurers have different rules: Unlike Medicare, they tend to pay for a comprehensive well-woman exam each year, billed using 1 of the CPT preventive medicine codes (99381 to 99397). The diagnostic coding is also different—specifically V72.3, gynecologic exam with Pap smear.

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-9CM coding. When in doubt on a coding or billing matter, check with your individual payer.

Queens County (NY) Supreme Court

A 32-year-old pregnant woman was diagnosed with a large fibroid that blocked her birth canal and prevented vaginal delivery.

When she presented to a hospital for cesarean delivery, the physician performed a low transverse incision and encountered bleeding. He then switched to an inverted “T” incision and delivered the infant safely. The mother, however, continued to bleed and required a hysterectomy.

In suing, the woman claimed that the physician should have performed a vertical incision, as the low transverse incision caused excessive bleeding. She added that in making the improper incision the physician might have cut the fibroid or its blood supply.

The doctor argued that he had used proper judgment in selecting a low transverse incision. He claimed that a higher incision would have put the baby at risk for injury.

• The jury awarded the plaintiff $750,000.
  

Queens County (NY) Supreme Court

A 32-year-old pregnant woman was diagnosed with a large fibroid that blocked her birth canal and prevented vaginal delivery.

When she presented to a hospital for cesarean delivery, the physician performed a low transverse incision and encountered bleeding. He then switched to an inverted “T” incision and delivered the infant safely. The mother, however, continued to bleed and required a hysterectomy.

In suing, the woman claimed that the physician should have performed a vertical incision, as the low transverse incision caused excessive bleeding. She added that in making the improper incision the physician might have cut the fibroid or its blood supply.

The doctor argued that he had used proper judgment in selecting a low transverse incision. He claimed that a higher incision would have put the baby at risk for injury.

• The jury awarded the plaintiff $750,000.
  

Queens County (NY) Supreme Court

A 32-year-old pregnant woman was diagnosed with a large fibroid that blocked her birth canal and prevented vaginal delivery.

When she presented to a hospital for cesarean delivery, the physician performed a low transverse incision and encountered bleeding. He then switched to an inverted “T” incision and delivered the infant safely. The mother, however, continued to bleed and required a hysterectomy.

In suing, the woman claimed that the physician should have performed a vertical incision, as the low transverse incision caused excessive bleeding. She added that in making the improper incision the physician might have cut the fibroid or its blood supply.

The doctor argued that he had used proper judgment in selecting a low transverse incision. He claimed that a higher incision would have put the baby at risk for injury.

• The jury awarded the plaintiff $750,000.
  

Cook County (Ill) Circuit Court

Following a 6-hour trial of labor, a woman who had presented to a hospital for delivery underwent an emergency cesarean. The baby was delivered with severely depressed Apgar scores. Within 2 hours, he developed seizures and meconium aspiration syndrome. He died 26 hours later.

The parents sued, claiming that the physician and nursing staff should have performed the cesarean at least 30 minutes sooner. They added that the brain damage occurred during the last 10 minutes before delivery.

The physician and nursing staff contended that the cesarean was conducted in a timely and appropriate manner. Further, they maintained that the fetus suffered brain damage in utero, as a result of a triple nuchal cord and true knot in the umbilical cord.

• The jury returned a verdict for the defense.
  

Cook County (Ill) Circuit Court

Following a 6-hour trial of labor, a woman who had presented to a hospital for delivery underwent an emergency cesarean. The baby was delivered with severely depressed Apgar scores. Within 2 hours, he developed seizures and meconium aspiration syndrome. He died 26 hours later.

The parents sued, claiming that the physician and nursing staff should have performed the cesarean at least 30 minutes sooner. They added that the brain damage occurred during the last 10 minutes before delivery.

The physician and nursing staff contended that the cesarean was conducted in a timely and appropriate manner. Further, they maintained that the fetus suffered brain damage in utero, as a result of a triple nuchal cord and true knot in the umbilical cord.

• The jury returned a verdict for the defense.
  

Cook County (Ill) Circuit Court

Following a 6-hour trial of labor, a woman who had presented to a hospital for delivery underwent an emergency cesarean. The baby was delivered with severely depressed Apgar scores. Within 2 hours, he developed seizures and meconium aspiration syndrome. He died 26 hours later.

The parents sued, claiming that the physician and nursing staff should have performed the cesarean at least 30 minutes sooner. They added that the brain damage occurred during the last 10 minutes before delivery.

The physician and nursing staff contended that the cesarean was conducted in a timely and appropriate manner. Further, they maintained that the fetus suffered brain damage in utero, as a result of a triple nuchal cord and true knot in the umbilical cord.

• The jury returned a verdict for the defense.
  

Queens County (NY) Supreme Court

A 37-year-old woman presented to her Ob/Gyn complaining of bleeding. She reported positive results from a home pregnancy test, as well as a prior cystectomy on her left ovary and prior cesarean delivery.

The doctor confirmed the pregnancy with a urine pregnancy test and advised the patient to stay off her feet to avoid miscarriage. She was directed to return for a sonogram 9 days later.

Three days later, the patient returned complaining of severe abdominal pain and increased bleeding. She was diagnosed with a probable rupture and ectopic pregnancy and sent to a hospital, where she underwent a laparotomy with removal of the ruptured tube.

In suing, the patient argued that, given her medical history, the physician should have performed a ß-human chorionic gonadotropin pregnancy test and sonogram to rule out an ectopic pregnancy. The woman also noted that in phone calls informing her physician of her severe abdominal pain she was told to stay off her feet and take over-thecounter pain medication.

The doctor argued that prior to the rupture there was not enough time for serial ßhuman chorionic gonadotropin testing and that a sonogram would not necessarily reveal an ectopic pregnancy.

• The case settled for $175,000.
  

Queens County (NY) Supreme Court

A 37-year-old woman presented to her Ob/Gyn complaining of bleeding. She reported positive results from a home pregnancy test, as well as a prior cystectomy on her left ovary and prior cesarean delivery.

The doctor confirmed the pregnancy with a urine pregnancy test and advised the patient to stay off her feet to avoid miscarriage. She was directed to return for a sonogram 9 days later.

Three days later, the patient returned complaining of severe abdominal pain and increased bleeding. She was diagnosed with a probable rupture and ectopic pregnancy and sent to a hospital, where she underwent a laparotomy with removal of the ruptured tube.

In suing, the patient argued that, given her medical history, the physician should have performed a ß-human chorionic gonadotropin pregnancy test and sonogram to rule out an ectopic pregnancy. The woman also noted that in phone calls informing her physician of her severe abdominal pain she was told to stay off her feet and take over-thecounter pain medication.

The doctor argued that prior to the rupture there was not enough time for serial ßhuman chorionic gonadotropin testing and that a sonogram would not necessarily reveal an ectopic pregnancy.

• The case settled for $175,000.
  

Queens County (NY) Supreme Court

A 37-year-old woman presented to her Ob/Gyn complaining of bleeding. She reported positive results from a home pregnancy test, as well as a prior cystectomy on her left ovary and prior cesarean delivery.

The doctor confirmed the pregnancy with a urine pregnancy test and advised the patient to stay off her feet to avoid miscarriage. She was directed to return for a sonogram 9 days later.

Three days later, the patient returned complaining of severe abdominal pain and increased bleeding. She was diagnosed with a probable rupture and ectopic pregnancy and sent to a hospital, where she underwent a laparotomy with removal of the ruptured tube.

In suing, the patient argued that, given her medical history, the physician should have performed a ß-human chorionic gonadotropin pregnancy test and sonogram to rule out an ectopic pregnancy. The woman also noted that in phone calls informing her physician of her severe abdominal pain she was told to stay off her feet and take over-thecounter pain medication.

The doctor argued that prior to the rupture there was not enough time for serial ßhuman chorionic gonadotropin testing and that a sonogram would not necessarily reveal an ectopic pregnancy.

• The case settled for $175,000.
  

Fulton County (Ga) State Court

A woman at 28 weeks’ gestation presented to her Ob/Gyn with a rash on her hands. She was referred to a dermatologist.

During a routine pregnancy visit at 30 weeks’ gestation, the patient asked her physician questions about fetal movement. The doctor ordered an ultrasound 1 week later to check on fetal growth.

The ultrasound revealed intrauterine fetal demise. The stillborn was delivered. Placental pathology revealed both a clotting disorder and a severe fetal infection. In addition, after delivery, the woman’s skin condition was diagnosed as a rare disease affecting the connective tissue that is commonly associated with fetal loss.

In suing, the woman claimed that she had alerted her doctor about reduced fetal movement and should have been referred for a nonstress test and/or a biophysical profile. She contended that if prenatal testing had been conducted, prompt delivery could have saved the fetus’s life.

The doctor argued that scheduling an ultrasound 1 week later was well within the standard of care. The physician also denied that the plaintiff made any complaints of reduced fetal movement and contended that the patient’s disease increases her risk of fetal loss. Further, the doctor noted that placental pathology revealed intravillus fibrin deposition, along with a fetal infection.

• The jury returned a verdict for the defense.
  

Fulton County (Ga) State Court

A woman at 28 weeks’ gestation presented to her Ob/Gyn with a rash on her hands. She was referred to a dermatologist.

During a routine pregnancy visit at 30 weeks’ gestation, the patient asked her physician questions about fetal movement. The doctor ordered an ultrasound 1 week later to check on fetal growth.

The ultrasound revealed intrauterine fetal demise. The stillborn was delivered. Placental pathology revealed both a clotting disorder and a severe fetal infection. In addition, after delivery, the woman’s skin condition was diagnosed as a rare disease affecting the connective tissue that is commonly associated with fetal loss.

In suing, the woman claimed that she had alerted her doctor about reduced fetal movement and should have been referred for a nonstress test and/or a biophysical profile. She contended that if prenatal testing had been conducted, prompt delivery could have saved the fetus’s life.

The doctor argued that scheduling an ultrasound 1 week later was well within the standard of care. The physician also denied that the plaintiff made any complaints of reduced fetal movement and contended that the patient’s disease increases her risk of fetal loss. Further, the doctor noted that placental pathology revealed intravillus fibrin deposition, along with a fetal infection.

• The jury returned a verdict for the defense.
  

Fulton County (Ga) State Court

A woman at 28 weeks’ gestation presented to her Ob/Gyn with a rash on her hands. She was referred to a dermatologist.

During a routine pregnancy visit at 30 weeks’ gestation, the patient asked her physician questions about fetal movement. The doctor ordered an ultrasound 1 week later to check on fetal growth.

The ultrasound revealed intrauterine fetal demise. The stillborn was delivered. Placental pathology revealed both a clotting disorder and a severe fetal infection. In addition, after delivery, the woman’s skin condition was diagnosed as a rare disease affecting the connective tissue that is commonly associated with fetal loss.

In suing, the woman claimed that she had alerted her doctor about reduced fetal movement and should have been referred for a nonstress test and/or a biophysical profile. She contended that if prenatal testing had been conducted, prompt delivery could have saved the fetus’s life.

The doctor argued that scheduling an ultrasound 1 week later was well within the standard of care. The physician also denied that the plaintiff made any complaints of reduced fetal movement and contended that the patient’s disease increases her risk of fetal loss. Further, the doctor noted that placental pathology revealed intravillus fibrin deposition, along with a fetal infection.

• The jury returned a verdict for the defense.
  

Bronx County (NY) Supreme Court

Upon presentation at a clinic for an abortion, a 19-year-old patient at 20 weeks’ gestation had laminaria inserted to dilate her cervix. She returned the following day for insertion of additional laminaria.

Two days after the initial procedure, she presented for completion of the abortion. During the procedure, the patient’s cervix was lacerated and her uterus perforated. The physician then performed an ultrasound and discovered fetal parts floating in the woman’s abdomen.

She was transferred to a hospital, where she underwent a hysterotomy and exploratory laparotomy. She was hospitalized for 2 weeks and advised that she would have difficulty becoming pregnant and carrying a baby to term. Two years later, however, she delivered vaginally without complication.

In suing, the patient argued that the clinic physician performed the abortion prematurely, before her cervix was fully dilated.

The doctor contended that her complications were a known risk of the procedure.

• The case settled for $285,000.
  

Bronx County (NY) Supreme Court

Upon presentation at a clinic for an abortion, a 19-year-old patient at 20 weeks’ gestation had laminaria inserted to dilate her cervix. She returned the following day for insertion of additional laminaria.

Two days after the initial procedure, she presented for completion of the abortion. During the procedure, the patient’s cervix was lacerated and her uterus perforated. The physician then performed an ultrasound and discovered fetal parts floating in the woman’s abdomen.

She was transferred to a hospital, where she underwent a hysterotomy and exploratory laparotomy. She was hospitalized for 2 weeks and advised that she would have difficulty becoming pregnant and carrying a baby to term. Two years later, however, she delivered vaginally without complication.

In suing, the patient argued that the clinic physician performed the abortion prematurely, before her cervix was fully dilated.

The doctor contended that her complications were a known risk of the procedure.

• The case settled for $285,000.
  

Bronx County (NY) Supreme Court

Upon presentation at a clinic for an abortion, a 19-year-old patient at 20 weeks’ gestation had laminaria inserted to dilate her cervix. She returned the following day for insertion of additional laminaria.

Two days after the initial procedure, she presented for completion of the abortion. During the procedure, the patient’s cervix was lacerated and her uterus perforated. The physician then performed an ultrasound and discovered fetal parts floating in the woman’s abdomen.

She was transferred to a hospital, where she underwent a hysterotomy and exploratory laparotomy. She was hospitalized for 2 weeks and advised that she would have difficulty becoming pregnant and carrying a baby to term. Two years later, however, she delivered vaginally without complication.

In suing, the patient argued that the clinic physician performed the abortion prematurely, before her cervix was fully dilated.

The doctor contended that her complications were a known risk of the procedure.

• The case settled for $285,000.
  

Cole County (Mo) Circuit Court

During trocar placement for elective tubal ligation, the small bowel of a 43-year-old patient was perforated in 2 places. In addition, her right common iliac artery was punctured and her mesentery cut. The woman allegedly suffers from pain in her abdomen and groin, along with right leg fatigue.

In suing, the patient claimed that the physician inserted the trocar at an improper angle and pushed it too deeply into her abdomen.

The doctor contended that he inserted the trocar properly and that the injuries were a known risk of the procedure.

• The jury awarded the plaintiff $300,000.
  

Cole County (Mo) Circuit Court

During trocar placement for elective tubal ligation, the small bowel of a 43-year-old patient was perforated in 2 places. In addition, her right common iliac artery was punctured and her mesentery cut. The woman allegedly suffers from pain in her abdomen and groin, along with right leg fatigue.

In suing, the patient claimed that the physician inserted the trocar at an improper angle and pushed it too deeply into her abdomen.

The doctor contended that he inserted the trocar properly and that the injuries were a known risk of the procedure.

• The jury awarded the plaintiff $300,000.
  

Cole County (Mo) Circuit Court

During trocar placement for elective tubal ligation, the small bowel of a 43-year-old patient was perforated in 2 places. In addition, her right common iliac artery was punctured and her mesentery cut. The woman allegedly suffers from pain in her abdomen and groin, along with right leg fatigue.

In suing, the patient claimed that the physician inserted the trocar at an improper angle and pushed it too deeply into her abdomen.

The doctor contended that he inserted the trocar properly and that the injuries were a known risk of the procedure.

• The jury awarded the plaintiff $300,000.