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Did excessive traction lead to brachial plexus injury?
Following shoulder dystocia, an infant was born with brachial plexus injury, which resulted in partial paralysis of her right arm.
In suing, the plaintiff—who was 15 years old at trial—claimed that the physician applied excessive downward traction at the time of the dystocia.
The physician countered that the injury was caused in utero and during delivery due to uterine contractions, expulsive forces of labor, and normal traction.
- The jury awarded the plaintiff $900,000.
Following shoulder dystocia, an infant was born with brachial plexus injury, which resulted in partial paralysis of her right arm.
In suing, the plaintiff—who was 15 years old at trial—claimed that the physician applied excessive downward traction at the time of the dystocia.
The physician countered that the injury was caused in utero and during delivery due to uterine contractions, expulsive forces of labor, and normal traction.
- The jury awarded the plaintiff $900,000.
Following shoulder dystocia, an infant was born with brachial plexus injury, which resulted in partial paralysis of her right arm.
In suing, the plaintiff—who was 15 years old at trial—claimed that the physician applied excessive downward traction at the time of the dystocia.
The physician countered that the injury was caused in utero and during delivery due to uterine contractions, expulsive forces of labor, and normal traction.
- The jury awarded the plaintiff $900,000.
Depression, anxiety attributed to erroneous HIV diagnosis
A woman at 30 weeks’ gestation was diagnosed with HIV.
She began a course of medication that included azidothymidine, but never developed symptoms of HIV. Four years later another laboratory test indicated that the initial HIV diagnosis was incorrect.
In suing, the woman claimed she suffered from severe depression and anxiety as a result of the misdiagnosis.
The hospital contended that it did not violate the patient’s standard of care.
- The jury awarded the plaintiff $1.1 million. A posttrial motion to cap damages at $250,000 is pending.
A woman at 30 weeks’ gestation was diagnosed with HIV.
She began a course of medication that included azidothymidine, but never developed symptoms of HIV. Four years later another laboratory test indicated that the initial HIV diagnosis was incorrect.
In suing, the woman claimed she suffered from severe depression and anxiety as a result of the misdiagnosis.
The hospital contended that it did not violate the patient’s standard of care.
- The jury awarded the plaintiff $1.1 million. A posttrial motion to cap damages at $250,000 is pending.
A woman at 30 weeks’ gestation was diagnosed with HIV.
She began a course of medication that included azidothymidine, but never developed symptoms of HIV. Four years later another laboratory test indicated that the initial HIV diagnosis was incorrect.
In suing, the woman claimed she suffered from severe depression and anxiety as a result of the misdiagnosis.
The hospital contended that it did not violate the patient’s standard of care.
- The jury awarded the plaintiff $1.1 million. A posttrial motion to cap damages at $250,000 is pending.
Did misread mammogram lead to mastectomy?
Upon presenting to her primary care physician, a 45-year-old woman complained of a mass in her breast. A mammogram performed at a breast center yielded negative results.
Later, the patient required a mastectomy and several breast reconstruction procedures.
In suing, the woman argued that the physician failed to refer her to a surgeon after the mammogram. She added that the lack of a timely referral delayed her diagnosis. She also claimed the breast center was negligent for not telling her to follow-up with her physician.
The physician argued that he was not negligent, since he referred the patient to the breast center for mammography and ultrasound and relied on the radiology report that came back negative. In addition, the physician claimed that any delay in diagnosis did not alter the patient’s treatment options. The breast center claimed that its reporting was not negligent.
- The jury returned a verdict for the defense.
Upon presenting to her primary care physician, a 45-year-old woman complained of a mass in her breast. A mammogram performed at a breast center yielded negative results.
Later, the patient required a mastectomy and several breast reconstruction procedures.
In suing, the woman argued that the physician failed to refer her to a surgeon after the mammogram. She added that the lack of a timely referral delayed her diagnosis. She also claimed the breast center was negligent for not telling her to follow-up with her physician.
The physician argued that he was not negligent, since he referred the patient to the breast center for mammography and ultrasound and relied on the radiology report that came back negative. In addition, the physician claimed that any delay in diagnosis did not alter the patient’s treatment options. The breast center claimed that its reporting was not negligent.
- The jury returned a verdict for the defense.
Upon presenting to her primary care physician, a 45-year-old woman complained of a mass in her breast. A mammogram performed at a breast center yielded negative results.
Later, the patient required a mastectomy and several breast reconstruction procedures.
In suing, the woman argued that the physician failed to refer her to a surgeon after the mammogram. She added that the lack of a timely referral delayed her diagnosis. She also claimed the breast center was negligent for not telling her to follow-up with her physician.
The physician argued that he was not negligent, since he referred the patient to the breast center for mammography and ultrasound and relied on the radiology report that came back negative. In addition, the physician claimed that any delay in diagnosis did not alter the patient’s treatment options. The breast center claimed that its reporting was not negligent.
- The jury returned a verdict for the defense.
Sponge left in abdomen leads to pain, infertility
Three weeks after a successful cesarean delivery, a woman complained to her physician of pain and discomfort in the lower right quadrant of her abdomen. The physician ordered a series of blood tests and advised the woman that her pain was the result of a hematoma that would heal itself with time. However, the pain did not subside on its own.
Some time later, an x-ray of the abdomen revealed a retained surgical sponge, which was removed via laparotomy.
In suing, the woman claimed that she suffered damage to her reproductive organs as a result of the physician’s negligence. In addition, she cannot conceive naturally.
- The jury awarded the plaintiff $438,686.
Three weeks after a successful cesarean delivery, a woman complained to her physician of pain and discomfort in the lower right quadrant of her abdomen. The physician ordered a series of blood tests and advised the woman that her pain was the result of a hematoma that would heal itself with time. However, the pain did not subside on its own.
Some time later, an x-ray of the abdomen revealed a retained surgical sponge, which was removed via laparotomy.
In suing, the woman claimed that she suffered damage to her reproductive organs as a result of the physician’s negligence. In addition, she cannot conceive naturally.
- The jury awarded the plaintiff $438,686.
Three weeks after a successful cesarean delivery, a woman complained to her physician of pain and discomfort in the lower right quadrant of her abdomen. The physician ordered a series of blood tests and advised the woman that her pain was the result of a hematoma that would heal itself with time. However, the pain did not subside on its own.
Some time later, an x-ray of the abdomen revealed a retained surgical sponge, which was removed via laparotomy.
In suing, the woman claimed that she suffered damage to her reproductive organs as a result of the physician’s negligence. In addition, she cannot conceive naturally.
- The jury awarded the plaintiff $438,686.
Adhesions and ovarian excrescence
The payer is unlikely to reimburse separately for peritoneal washings and biopsy.
The payer is unlikely to reimburse separately for peritoneal washings and biopsy.
The payer is unlikely to reimburse separately for peritoneal washings and biopsy.
Coding for sacrospinous ligament fixation
Q: How would you code a sacrospinous ligament vaginal suspension, repair of enterocele, and cystocele? This is a Medicare patient with a preoperative diagnosis of total vaginal prolapse, status post-vaginal hysterectomy with anterior and posterior repair, third-degree enterocele, and second-degree rectocele recurrent.
A: When coding any surgery for Medicare submission, it’s always a good idea to check the Correct Coding Initiative (CCI) to see which code combinations are bundled. In this case, the codes you can choose from include 57282 (for sacrospinous ligament fixation), 57240 (for cystocele repair), and 57268 (for vaginal-approach enterocele repair).
Unfortunately, CCI indicates code 57268 is not payable with code 57282. To make matters worse, you can’t bypass the edit, since this code combination is never paid. According to CCI, this is because the vaginal-approach enterocele repair is a CPT “separate procedure” and Medicare has decided that it and the sacrospinous ligament fixation are always integral to each other.
If this had been a case where a posterior repair had been done along with the anterior colporrhaphy and enterocele repair, you could have assigned code 57265 (combined antero-posterior colporrhaphy; with enterocele repair) as your second procedure, since it isn’t bundled with the sacrospinous ligament fixation procedure. You may be tempted, then, to bill code 57265 with a modifier -52 (reduced services) to get the claim paid, but I would advise against it, as this coding isn’t the most accurate description of what was done.
Instead, because there was a symptomatic enterocele that needed to be repaired, I would add a modifier -22 (unusual procedure) to code 57282 and send in supporting documentation regarding the need for the enterocele repair. Centers for Medicare & Medicaid Services staff recommended this solution a few years ago for any procedure that’s always bundled into a larger procedure, when the documentation supports performing it.
Q: How would you code a sacrospinous ligament vaginal suspension, repair of enterocele, and cystocele? This is a Medicare patient with a preoperative diagnosis of total vaginal prolapse, status post-vaginal hysterectomy with anterior and posterior repair, third-degree enterocele, and second-degree rectocele recurrent.
A: When coding any surgery for Medicare submission, it’s always a good idea to check the Correct Coding Initiative (CCI) to see which code combinations are bundled. In this case, the codes you can choose from include 57282 (for sacrospinous ligament fixation), 57240 (for cystocele repair), and 57268 (for vaginal-approach enterocele repair).
Unfortunately, CCI indicates code 57268 is not payable with code 57282. To make matters worse, you can’t bypass the edit, since this code combination is never paid. According to CCI, this is because the vaginal-approach enterocele repair is a CPT “separate procedure” and Medicare has decided that it and the sacrospinous ligament fixation are always integral to each other.
If this had been a case where a posterior repair had been done along with the anterior colporrhaphy and enterocele repair, you could have assigned code 57265 (combined antero-posterior colporrhaphy; with enterocele repair) as your second procedure, since it isn’t bundled with the sacrospinous ligament fixation procedure. You may be tempted, then, to bill code 57265 with a modifier -52 (reduced services) to get the claim paid, but I would advise against it, as this coding isn’t the most accurate description of what was done.
Instead, because there was a symptomatic enterocele that needed to be repaired, I would add a modifier -22 (unusual procedure) to code 57282 and send in supporting documentation regarding the need for the enterocele repair. Centers for Medicare & Medicaid Services staff recommended this solution a few years ago for any procedure that’s always bundled into a larger procedure, when the documentation supports performing it.
Q: How would you code a sacrospinous ligament vaginal suspension, repair of enterocele, and cystocele? This is a Medicare patient with a preoperative diagnosis of total vaginal prolapse, status post-vaginal hysterectomy with anterior and posterior repair, third-degree enterocele, and second-degree rectocele recurrent.
A: When coding any surgery for Medicare submission, it’s always a good idea to check the Correct Coding Initiative (CCI) to see which code combinations are bundled. In this case, the codes you can choose from include 57282 (for sacrospinous ligament fixation), 57240 (for cystocele repair), and 57268 (for vaginal-approach enterocele repair).
Unfortunately, CCI indicates code 57268 is not payable with code 57282. To make matters worse, you can’t bypass the edit, since this code combination is never paid. According to CCI, this is because the vaginal-approach enterocele repair is a CPT “separate procedure” and Medicare has decided that it and the sacrospinous ligament fixation are always integral to each other.
If this had been a case where a posterior repair had been done along with the anterior colporrhaphy and enterocele repair, you could have assigned code 57265 (combined antero-posterior colporrhaphy; with enterocele repair) as your second procedure, since it isn’t bundled with the sacrospinous ligament fixation procedure. You may be tempted, then, to bill code 57265 with a modifier -52 (reduced services) to get the claim paid, but I would advise against it, as this coding isn’t the most accurate description of what was done.
Instead, because there was a symptomatic enterocele that needed to be repaired, I would add a modifier -22 (unusual procedure) to code 57282 and send in supporting documentation regarding the need for the enterocele repair. Centers for Medicare & Medicaid Services staff recommended this solution a few years ago for any procedure that’s always bundled into a larger procedure, when the documentation supports performing it.
Was infant death a result of vacuum extractor misuse?
A woman at 41 weeks’ gestation presented to her Ob/Gyn for the induction of labor. The doctor used a vacuum extractor to rotate and deliver the infant. During delivery, a tight nuchal cord was noted and cut before the delivery of the infant’s shoulders. The baby died 2 days later of multiorgan system failure.
In suing, the mother contended that the physician was negligent in using a vacuum extractor to deliver an infant from a persistent posterior position. In addition, the mother claimed that her child’s death was due to a subgaleal hemorrhage directly caused by the vacuum extractor.
The physician argued that the infant’s hemorrhage and death were caused by viral sepsis and developing disseminated intravascular coagulation.
- The case settled for $250,000.
A woman at 41 weeks’ gestation presented to her Ob/Gyn for the induction of labor. The doctor used a vacuum extractor to rotate and deliver the infant. During delivery, a tight nuchal cord was noted and cut before the delivery of the infant’s shoulders. The baby died 2 days later of multiorgan system failure.
In suing, the mother contended that the physician was negligent in using a vacuum extractor to deliver an infant from a persistent posterior position. In addition, the mother claimed that her child’s death was due to a subgaleal hemorrhage directly caused by the vacuum extractor.
The physician argued that the infant’s hemorrhage and death were caused by viral sepsis and developing disseminated intravascular coagulation.
- The case settled for $250,000.
A woman at 41 weeks’ gestation presented to her Ob/Gyn for the induction of labor. The doctor used a vacuum extractor to rotate and deliver the infant. During delivery, a tight nuchal cord was noted and cut before the delivery of the infant’s shoulders. The baby died 2 days later of multiorgan system failure.
In suing, the mother contended that the physician was negligent in using a vacuum extractor to deliver an infant from a persistent posterior position. In addition, the mother claimed that her child’s death was due to a subgaleal hemorrhage directly caused by the vacuum extractor.
The physician argued that the infant’s hemorrhage and death were caused by viral sepsis and developing disseminated intravascular coagulation.
- The case settled for $250,000.
Did failure to treat chlamydia lead to cerebral palsy?
At 27 weeks’ gestation, a woman pregnant with twins presented to a hospital with unstoppable preterm labor. While the first twin delivered without complication, the second now suffers from cerebral palsy.
In suing, the mother claimed that she prematurely delivered because the medical staff failed to treat her chlamydia infection.
The medical staff contended that the mother’s failure to attend prenatal visits led to the premature delivery. In addition, they argued that twin-twin transfusion may have caused the second child’s complications.
- The case settled for $2.1 million.
At 27 weeks’ gestation, a woman pregnant with twins presented to a hospital with unstoppable preterm labor. While the first twin delivered without complication, the second now suffers from cerebral palsy.
In suing, the mother claimed that she prematurely delivered because the medical staff failed to treat her chlamydia infection.
The medical staff contended that the mother’s failure to attend prenatal visits led to the premature delivery. In addition, they argued that twin-twin transfusion may have caused the second child’s complications.
- The case settled for $2.1 million.
At 27 weeks’ gestation, a woman pregnant with twins presented to a hospital with unstoppable preterm labor. While the first twin delivered without complication, the second now suffers from cerebral palsy.
In suing, the mother claimed that she prematurely delivered because the medical staff failed to treat her chlamydia infection.
The medical staff contended that the mother’s failure to attend prenatal visits led to the premature delivery. In addition, they argued that twin-twin transfusion may have caused the second child’s complications.
- The case settled for $2.1 million.
Bowel resection necessary after ovarian cyst removal
To determine whether an ovarian cyst was cancerous, a 46-year-old woman underwent a laparoscopic salpingo-oophorectomy. Postoperatively, the woman complained of nausea, vomiting, and pain. She ultimately required surgery to have a portion of her bowel resected.
In suing, the patient claimed that during the laparoscopic procedure her small intestine was burned with a cautery instrument, which doctors failed to diagnose. Further, she argued that a computed tomography scan should have been performed when she returned to the hospital’s emergency room. She contended that the physicians’ negligence led to increased infection, which ultimately resulted in the surgical resection.
The physicians argued that the patient was informed of her risks and that proper inspection of her bowel was made at the time of surgery. Further, they contended that the burn on her small intestine, which developed into a 2-mm perforation, would not have been detectable during surgery.
- The case settled for $378,500.
To determine whether an ovarian cyst was cancerous, a 46-year-old woman underwent a laparoscopic salpingo-oophorectomy. Postoperatively, the woman complained of nausea, vomiting, and pain. She ultimately required surgery to have a portion of her bowel resected.
In suing, the patient claimed that during the laparoscopic procedure her small intestine was burned with a cautery instrument, which doctors failed to diagnose. Further, she argued that a computed tomography scan should have been performed when she returned to the hospital’s emergency room. She contended that the physicians’ negligence led to increased infection, which ultimately resulted in the surgical resection.
The physicians argued that the patient was informed of her risks and that proper inspection of her bowel was made at the time of surgery. Further, they contended that the burn on her small intestine, which developed into a 2-mm perforation, would not have been detectable during surgery.
- The case settled for $378,500.
To determine whether an ovarian cyst was cancerous, a 46-year-old woman underwent a laparoscopic salpingo-oophorectomy. Postoperatively, the woman complained of nausea, vomiting, and pain. She ultimately required surgery to have a portion of her bowel resected.
In suing, the patient claimed that during the laparoscopic procedure her small intestine was burned with a cautery instrument, which doctors failed to diagnose. Further, she argued that a computed tomography scan should have been performed when she returned to the hospital’s emergency room. She contended that the physicians’ negligence led to increased infection, which ultimately resulted in the surgical resection.
The physicians argued that the patient was informed of her risks and that proper inspection of her bowel was made at the time of surgery. Further, they contended that the burn on her small intestine, which developed into a 2-mm perforation, would not have been detectable during surgery.
- The case settled for $378,500.
Were post-D&C injections necessary?
A 39-year-old woman presented to her physician with complaints of vaginal bleeding in March 1997. Upon examination, the physician diagnosed fibroid tumors in the uterus. The doctor recommended dilatation and curettage (D&C), which was performed the same day. Three days later, the patient received a leuprolide acetate injection; in April and May she received 2 follow-up injections of the medication.
In July 1997, the woman underwent a myomectomy. No fibroid tumors were found during this procedure. One week later, the patient was readmitted with complaints of extreme stomach pains. Surgery was performed to remove adhesions that were causing the pain. The woman continues to suffer from nausea, heartburn, vomiting, painful intercourse, and bowel restriction.
In suing, the patient claimed that the physician did not wait sufficient time to see if the D&C alone would have solved the problem. The plaintiff claimed that both the leuprolide injections and the “myomectomy” that revealed no uterine myomas were unnecesary.
The physician maintained that the examinations and procedures were adequate.
- The jury awarded the plaintiff $1 million.
A 39-year-old woman presented to her physician with complaints of vaginal bleeding in March 1997. Upon examination, the physician diagnosed fibroid tumors in the uterus. The doctor recommended dilatation and curettage (D&C), which was performed the same day. Three days later, the patient received a leuprolide acetate injection; in April and May she received 2 follow-up injections of the medication.
In July 1997, the woman underwent a myomectomy. No fibroid tumors were found during this procedure. One week later, the patient was readmitted with complaints of extreme stomach pains. Surgery was performed to remove adhesions that were causing the pain. The woman continues to suffer from nausea, heartburn, vomiting, painful intercourse, and bowel restriction.
In suing, the patient claimed that the physician did not wait sufficient time to see if the D&C alone would have solved the problem. The plaintiff claimed that both the leuprolide injections and the “myomectomy” that revealed no uterine myomas were unnecesary.
The physician maintained that the examinations and procedures were adequate.
- The jury awarded the plaintiff $1 million.
A 39-year-old woman presented to her physician with complaints of vaginal bleeding in March 1997. Upon examination, the physician diagnosed fibroid tumors in the uterus. The doctor recommended dilatation and curettage (D&C), which was performed the same day. Three days later, the patient received a leuprolide acetate injection; in April and May she received 2 follow-up injections of the medication.
In July 1997, the woman underwent a myomectomy. No fibroid tumors were found during this procedure. One week later, the patient was readmitted with complaints of extreme stomach pains. Surgery was performed to remove adhesions that were causing the pain. The woman continues to suffer from nausea, heartburn, vomiting, painful intercourse, and bowel restriction.
In suing, the patient claimed that the physician did not wait sufficient time to see if the D&C alone would have solved the problem. The plaintiff claimed that both the leuprolide injections and the “myomectomy” that revealed no uterine myomas were unnecesary.
The physician maintained that the examinations and procedures were adequate.
- The jury awarded the plaintiff $1 million.