Managing Your Practice

Philadelphia (Pa) Court Of Common Pleas—A woman with infertility and antiphospholipid antibody syndrome (APA) was advised to have heparin and aspirin therapy in addition to invitro fertilization. On the day of oocyte retrieval, 18 eggs were harvested. An ultrasound was performed immediately afterward, which showed a large amount of free fluid in the patient’s pelvis.

About 3 hours later, the patient underwent treatment for APA at another site, during which she became hypotensive. The nurse terminated the therapy and contacted the woman’s physician, who arrived about 90 minutes later. When he examined the patient, she was lethargic and hallucinating. At that time, her husband, an Ob/Gyn, was contacted. He transported her to the hospital where he worked and performed emergency surgery, discovering a massive hemoperitoneum. The bleeding was controlled, and the patient was transferred to an ICU postoperatively. However, 2 days later she suffered a cardiac arrest; 9 days later, she died.

In suing, the husband claimed the ultrasound had demonstrated a large amount of blood in his wife’s abdomen. Further, he argued that his wife bled for 5 hours while under the physician’s care.

The physician countered that he had not been made aware of the ultrasound findings. Additionally, he claimed the woman should have been taken to an emergency room and that her husband was emotionally distracted during the surgery. Furthermore, he maintained that since the decedent and her husband were both physicians, they were aware of the risks involved in administering aspirin during egg retrieval, including the possibility of internal bleeding.

The jury awarded the plaintiff $25 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.

Philadelphia (Pa) Court Of Common Pleas—A woman with infertility and antiphospholipid antibody syndrome (APA) was advised to have heparin and aspirin therapy in addition to invitro fertilization. On the day of oocyte retrieval, 18 eggs were harvested. An ultrasound was performed immediately afterward, which showed a large amount of free fluid in the patient’s pelvis.

About 3 hours later, the patient underwent treatment for APA at another site, during which she became hypotensive. The nurse terminated the therapy and contacted the woman’s physician, who arrived about 90 minutes later. When he examined the patient, she was lethargic and hallucinating. At that time, her husband, an Ob/Gyn, was contacted. He transported her to the hospital where he worked and performed emergency surgery, discovering a massive hemoperitoneum. The bleeding was controlled, and the patient was transferred to an ICU postoperatively. However, 2 days later she suffered a cardiac arrest; 9 days later, she died.

In suing, the husband claimed the ultrasound had demonstrated a large amount of blood in his wife’s abdomen. Further, he argued that his wife bled for 5 hours while under the physician’s care.

The physician countered that he had not been made aware of the ultrasound findings. Additionally, he claimed the woman should have been taken to an emergency room and that her husband was emotionally distracted during the surgery. Furthermore, he maintained that since the decedent and her husband were both physicians, they were aware of the risks involved in administering aspirin during egg retrieval, including the possibility of internal bleeding.

The jury awarded the plaintiff $25 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.

Philadelphia (Pa) Court Of Common Pleas—A woman with infertility and antiphospholipid antibody syndrome (APA) was advised to have heparin and aspirin therapy in addition to invitro fertilization. On the day of oocyte retrieval, 18 eggs were harvested. An ultrasound was performed immediately afterward, which showed a large amount of free fluid in the patient’s pelvis.

About 3 hours later, the patient underwent treatment for APA at another site, during which she became hypotensive. The nurse terminated the therapy and contacted the woman’s physician, who arrived about 90 minutes later. When he examined the patient, she was lethargic and hallucinating. At that time, her husband, an Ob/Gyn, was contacted. He transported her to the hospital where he worked and performed emergency surgery, discovering a massive hemoperitoneum. The bleeding was controlled, and the patient was transferred to an ICU postoperatively. However, 2 days later she suffered a cardiac arrest; 9 days later, she died.

In suing, the husband claimed the ultrasound had demonstrated a large amount of blood in his wife’s abdomen. Further, he argued that his wife bled for 5 hours while under the physician’s care.

The physician countered that he had not been made aware of the ultrasound findings. Additionally, he claimed the woman should have been taken to an emergency room and that her husband was emotionally distracted during the surgery. Furthermore, he maintained that since the decedent and her husband were both physicians, they were aware of the risks involved in administering aspirin during egg retrieval, including the possibility of internal bleeding.

The jury awarded the plaintiff $25 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.

Dutchess County(Ny) Supreme Court—After suffering a miscarriage on March 18, a woman underwent dilatation and evacuation (D & E). Following the procedure, she experienced lower abdominal pain, abnormal bleeding, and dyspareunia. A hysterosalpingogram was performed on May 26. Later that year, she developed pelvic inflammatory disease (PID) and underwent a diagnostic laparoscopy. Two years later, a hysterectomy and bilateral oophorectomy were performed.

In suing, the woman claimed that she developed an upper-reproductive-tract infection as a result of the hysterosalpingogram, which went undetected and led to PID. In addition, she argued that the obstetrician should have conducted diagnostic tests and prescribed antibiotics, thereby eliminating the need for hysterectomy.

The physician maintained that the patient had no signs or symptoms of an upper-reproductive-tract infection during her pelvic examinations; therefore, no testing was necessary. The defendant also argued that the patient did not suffer from PID but claimed the pathology report following her hysterectomy showed adenomyosis.

The jury returned a defense verdict.

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.

Dutchess County(Ny) Supreme Court—After suffering a miscarriage on March 18, a woman underwent dilatation and evacuation (D & E). Following the procedure, she experienced lower abdominal pain, abnormal bleeding, and dyspareunia. A hysterosalpingogram was performed on May 26. Later that year, she developed pelvic inflammatory disease (PID) and underwent a diagnostic laparoscopy. Two years later, a hysterectomy and bilateral oophorectomy were performed.

In suing, the woman claimed that she developed an upper-reproductive-tract infection as a result of the hysterosalpingogram, which went undetected and led to PID. In addition, she argued that the obstetrician should have conducted diagnostic tests and prescribed antibiotics, thereby eliminating the need for hysterectomy.

The physician maintained that the patient had no signs or symptoms of an upper-reproductive-tract infection during her pelvic examinations; therefore, no testing was necessary. The defendant also argued that the patient did not suffer from PID but claimed the pathology report following her hysterectomy showed adenomyosis.

The jury returned a defense verdict.

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.

Dutchess County(Ny) Supreme Court—After suffering a miscarriage on March 18, a woman underwent dilatation and evacuation (D & E). Following the procedure, she experienced lower abdominal pain, abnormal bleeding, and dyspareunia. A hysterosalpingogram was performed on May 26. Later that year, she developed pelvic inflammatory disease (PID) and underwent a diagnostic laparoscopy. Two years later, a hysterectomy and bilateral oophorectomy were performed.

In suing, the woman claimed that she developed an upper-reproductive-tract infection as a result of the hysterosalpingogram, which went undetected and led to PID. In addition, she argued that the obstetrician should have conducted diagnostic tests and prescribed antibiotics, thereby eliminating the need for hysterectomy.

The physician maintained that the patient had no signs or symptoms of an upper-reproductive-tract infection during her pelvic examinations; therefore, no testing was necessary. The defendant also argued that the patient did not suffer from PID but claimed the pathology report following her hysterectomy showed adenomyosis.

The jury returned a defense verdict.

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.

Los Angeles County (Calif) Superior Court—On June 22, a gravida presented to a clinic complaining she had not felt fetal movement for the past week. On June 24, an ultrasound revealed marked oligohydramnios. The patient immediately underwent a nonstress test, which demonstrated a non-reassuring fetal heart rate (FHR) pattern at 3:30 p.m. As such, the family practitioner determined that the baby needed to be delivered by cesarean section and promptly contacted an Ob/Gyn. The physician was called again at 4:30 p.m. and arrived at 5:18 p.m. The baby was delivered via cesarean section at 6:08 p.m.

At delivery, the infant was heavily stained with meconium and the umbilical cord was wrapped around his neck 4 times. The child is now blind, microcephalic, tube-fed, and requires supplemental oxygen.

In suing, the parents contended that the Ob/Gyn was negligent for the following: not ascertaining the true nature of the fetal distress at 3:30 p.m., arriving at the hospital approximately 1 hour and 45 minutes after the initial call, and waiting 50 minutes to deliver the infant.

The physician maintained that the neurologic damage occurred 3 to 5 hours prior to delivery based on the presentation of the infant at delivery, the placental pathology, and the FHR tracing.

The jury returned a defense verdict.

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.

Los Angeles County (Calif) Superior Court—On June 22, a gravida presented to a clinic complaining she had not felt fetal movement for the past week. On June 24, an ultrasound revealed marked oligohydramnios. The patient immediately underwent a nonstress test, which demonstrated a non-reassuring fetal heart rate (FHR) pattern at 3:30 p.m. As such, the family practitioner determined that the baby needed to be delivered by cesarean section and promptly contacted an Ob/Gyn. The physician was called again at 4:30 p.m. and arrived at 5:18 p.m. The baby was delivered via cesarean section at 6:08 p.m.

At delivery, the infant was heavily stained with meconium and the umbilical cord was wrapped around his neck 4 times. The child is now blind, microcephalic, tube-fed, and requires supplemental oxygen.

In suing, the parents contended that the Ob/Gyn was negligent for the following: not ascertaining the true nature of the fetal distress at 3:30 p.m., arriving at the hospital approximately 1 hour and 45 minutes after the initial call, and waiting 50 minutes to deliver the infant.

The physician maintained that the neurologic damage occurred 3 to 5 hours prior to delivery based on the presentation of the infant at delivery, the placental pathology, and the FHR tracing.

The jury returned a defense verdict.

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.

Los Angeles County (Calif) Superior Court—On June 22, a gravida presented to a clinic complaining she had not felt fetal movement for the past week. On June 24, an ultrasound revealed marked oligohydramnios. The patient immediately underwent a nonstress test, which demonstrated a non-reassuring fetal heart rate (FHR) pattern at 3:30 p.m. As such, the family practitioner determined that the baby needed to be delivered by cesarean section and promptly contacted an Ob/Gyn. The physician was called again at 4:30 p.m. and arrived at 5:18 p.m. The baby was delivered via cesarean section at 6:08 p.m.

At delivery, the infant was heavily stained with meconium and the umbilical cord was wrapped around his neck 4 times. The child is now blind, microcephalic, tube-fed, and requires supplemental oxygen.

In suing, the parents contended that the Ob/Gyn was negligent for the following: not ascertaining the true nature of the fetal distress at 3:30 p.m., arriving at the hospital approximately 1 hour and 45 minutes after the initial call, and waiting 50 minutes to deliver the infant.

The physician maintained that the neurologic damage occurred 3 to 5 hours prior to delivery based on the presentation of the infant at delivery, the placental pathology, and the FHR tracing.

The jury returned a defense verdict.

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.

San Diego County (Calif) Superior Court—A 21-year-old woman was treated for genital warts. At the end of her treatment, the physician applied what he believed to be a 5% acetic acid solution to her vulvar tissue. However, the nurse accidentally handed the doctor an 80% solution.

In suing, the patient claimed that the acid burned the “deep dermal” layer of her skin, causing subclinical neural damage and dyspareunia. As a result, she required biofeedback therapy, vaginal dilation, estrogen replacement therapy, and psychological counseling.

The Ob/Gyn argued that a minimal amount of 80% acetic acid was used and that the first- and second-degree genital burns the woman received were superficial, resolving within 3 months. Furthermore, he claimed that the source of the patient’s problems was vulvar vestibulitis, a condition that existed prior to her chemical burns.

The jury awarded the plaintiff $126,000.

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.

San Diego County (Calif) Superior Court—A 21-year-old woman was treated for genital warts. At the end of her treatment, the physician applied what he believed to be a 5% acetic acid solution to her vulvar tissue. However, the nurse accidentally handed the doctor an 80% solution.

In suing, the patient claimed that the acid burned the “deep dermal” layer of her skin, causing subclinical neural damage and dyspareunia. As a result, she required biofeedback therapy, vaginal dilation, estrogen replacement therapy, and psychological counseling.

The Ob/Gyn argued that a minimal amount of 80% acetic acid was used and that the first- and second-degree genital burns the woman received were superficial, resolving within 3 months. Furthermore, he claimed that the source of the patient’s problems was vulvar vestibulitis, a condition that existed prior to her chemical burns.

The jury awarded the plaintiff $126,000.

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.

San Diego County (Calif) Superior Court—A 21-year-old woman was treated for genital warts. At the end of her treatment, the physician applied what he believed to be a 5% acetic acid solution to her vulvar tissue. However, the nurse accidentally handed the doctor an 80% solution.

In suing, the patient claimed that the acid burned the “deep dermal” layer of her skin, causing subclinical neural damage and dyspareunia. As a result, she required biofeedback therapy, vaginal dilation, estrogen replacement therapy, and psychological counseling.

The Ob/Gyn argued that a minimal amount of 80% acetic acid was used and that the first- and second-degree genital burns the woman received were superficial, resolving within 3 months. Furthermore, he claimed that the source of the patient’s problems was vulvar vestibulitis, a condition that existed prior to her chemical burns.

The jury awarded the plaintiff $126,000.

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.

Manitowac county (Wis) Circuit court—A gravida presented to a hospital at term for induction of labor. The woman was placed on 56 mU of oxytocin and, after 18 hours, the cervix completely dilated. During that time, the nurse twice reduced the oxytocin due to concerns about decreasing variability in the fetal heart rate. However, the Ob/Gyn instructed the nurse to resume induction and let labor continue. The nurse then withdrew the oxytocin when late decelerations developed. Eventually, the decelerations disappeared and variability improved.

Early the next morning, the physician assessed the patient and noted that the fetal station was +1, the baby’s head was occiput posterior, and the mother had a narrow pubic arch. He attempted a vacuum delivery. After 20 minutes with only minimal progress and some rotation, he switched to forceps, delivered the fetal head, and encountered shoulder dystocia.

At birth, the baby was hypotonic and needed to be resuscitated, and her Apgars were 0 and 3. A 3-month MRI showed bilateral symmetrical basal ganglia damage. The child has severe cerebral palsy and spastic quadriparesis and needs a feeding tube.

In suing, the parents argued that the attempted rotation with the vacuum caused cord compression and deprived the fetus of adequate oxygen. The physician claimed he was using the + or -3 classification system for the station of the fetal head, asopposed to the + or -5 system. Therefore, he stated, his decision to opt for vacuum delivery when the fetal head was at +1 was within the standard of care.

The case settled before trial for $3.5 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.

Manitowac county (Wis) Circuit court—A gravida presented to a hospital at term for induction of labor. The woman was placed on 56 mU of oxytocin and, after 18 hours, the cervix completely dilated. During that time, the nurse twice reduced the oxytocin due to concerns about decreasing variability in the fetal heart rate. However, the Ob/Gyn instructed the nurse to resume induction and let labor continue. The nurse then withdrew the oxytocin when late decelerations developed. Eventually, the decelerations disappeared and variability improved.

Early the next morning, the physician assessed the patient and noted that the fetal station was +1, the baby’s head was occiput posterior, and the mother had a narrow pubic arch. He attempted a vacuum delivery. After 20 minutes with only minimal progress and some rotation, he switched to forceps, delivered the fetal head, and encountered shoulder dystocia.

At birth, the baby was hypotonic and needed to be resuscitated, and her Apgars were 0 and 3. A 3-month MRI showed bilateral symmetrical basal ganglia damage. The child has severe cerebral palsy and spastic quadriparesis and needs a feeding tube.

In suing, the parents argued that the attempted rotation with the vacuum caused cord compression and deprived the fetus of adequate oxygen. The physician claimed he was using the + or -3 classification system for the station of the fetal head, asopposed to the + or -5 system. Therefore, he stated, his decision to opt for vacuum delivery when the fetal head was at +1 was within the standard of care.

The case settled before trial for $3.5 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.

Manitowac county (Wis) Circuit court—A gravida presented to a hospital at term for induction of labor. The woman was placed on 56 mU of oxytocin and, after 18 hours, the cervix completely dilated. During that time, the nurse twice reduced the oxytocin due to concerns about decreasing variability in the fetal heart rate. However, the Ob/Gyn instructed the nurse to resume induction and let labor continue. The nurse then withdrew the oxytocin when late decelerations developed. Eventually, the decelerations disappeared and variability improved.

Early the next morning, the physician assessed the patient and noted that the fetal station was +1, the baby’s head was occiput posterior, and the mother had a narrow pubic arch. He attempted a vacuum delivery. After 20 minutes with only minimal progress and some rotation, he switched to forceps, delivered the fetal head, and encountered shoulder dystocia.

At birth, the baby was hypotonic and needed to be resuscitated, and her Apgars were 0 and 3. A 3-month MRI showed bilateral symmetrical basal ganglia damage. The child has severe cerebral palsy and spastic quadriparesis and needs a feeding tube.

In suing, the parents argued that the attempted rotation with the vacuum caused cord compression and deprived the fetus of adequate oxygen. The physician claimed he was using the + or -3 classification system for the station of the fetal head, asopposed to the + or -5 system. Therefore, he stated, his decision to opt for vacuum delivery when the fetal head was at +1 was within the standard of care.

The case settled before trial for $3.5 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.

Q Which CPT code should I use for an omental sling procedure in a patient who was recently diagnosed with cervical cancer?

A I assume that, with the diagnosis of cervical cancer, the omental sling was performed to prevent radiation damage to the small bowel during treatment for the disease. Therefore, report code 44700 (exclusion of small intestine or native tissue, e.g., bladder or omentum, from pelvis by mesh or other prosthesis).

This article was written by Melanie Witt, RN, CPC, MA, former program manager in the Department of Coding and Nomenclature at ACOG. She is now an independent coding and documentation consultant. Her comments reflect 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.

Q Which CPT code should I use for an omental sling procedure in a patient who was recently diagnosed with cervical cancer?

A I assume that, with the diagnosis of cervical cancer, the omental sling was performed to prevent radiation damage to the small bowel during treatment for the disease. Therefore, report code 44700 (exclusion of small intestine or native tissue, e.g., bladder or omentum, from pelvis by mesh or other prosthesis).

This article was written by Melanie Witt, RN, CPC, MA, former program manager in the Department of Coding and Nomenclature at ACOG. She is now an independent coding and documentation consultant. Her comments reflect 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.

Q Which CPT code should I use for an omental sling procedure in a patient who was recently diagnosed with cervical cancer?

A I assume that, with the diagnosis of cervical cancer, the omental sling was performed to prevent radiation damage to the small bowel during treatment for the disease. Therefore, report code 44700 (exclusion of small intestine or native tissue, e.g., bladder or omentum, from pelvis by mesh or other prosthesis).

This article was written by Melanie Witt, RN, CPC, MA, former program manager in the Department of Coding and Nomenclature at ACOG. She is now an independent coding and documentation consultant. Her comments reflect 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.

Q Which code should I report for a computed tomography (CT)-guided drainage of an ovarian cyst via a vaginal approach?

A You actually need to list 2 codes for this procedure. For the drainage of the cyst, report 58800 (vaginal approach). To bill for the CT guidance, report code 76003 (fluoroscopic guidance for needle placement, e.g., biopsy, aspiration, injection; localization device). This code is the best option because it most closely reflects the type of guidance used. (Fluoroscopic CT guidance is rapidly becoming the procedure of choice because it provides the physician with a continuous image of the needle’s position, whereas conventional CT guidance takes 1 picture at a time.)

This article was written by Melanie Witt, RN, CPC, MA, former program manager in the Department of Coding and Nomenclature at ACOG. She is now an independent coding and documentation consultant. Her comments reflect 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.

Q Which code should I report for a computed tomography (CT)-guided drainage of an ovarian cyst via a vaginal approach?

A You actually need to list 2 codes for this procedure. For the drainage of the cyst, report 58800 (vaginal approach). To bill for the CT guidance, report code 76003 (fluoroscopic guidance for needle placement, e.g., biopsy, aspiration, injection; localization device). This code is the best option because it most closely reflects the type of guidance used. (Fluoroscopic CT guidance is rapidly becoming the procedure of choice because it provides the physician with a continuous image of the needle’s position, whereas conventional CT guidance takes 1 picture at a time.)

This article was written by Melanie Witt, RN, CPC, MA, former program manager in the Department of Coding and Nomenclature at ACOG. She is now an independent coding and documentation consultant. Her comments reflect 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.

Q Which code should I report for a computed tomography (CT)-guided drainage of an ovarian cyst via a vaginal approach?

A You actually need to list 2 codes for this procedure. For the drainage of the cyst, report 58800 (vaginal approach). To bill for the CT guidance, report code 76003 (fluoroscopic guidance for needle placement, e.g., biopsy, aspiration, injection; localization device). This code is the best option because it most closely reflects the type of guidance used. (Fluoroscopic CT guidance is rapidly becoming the procedure of choice because it provides the physician with a continuous image of the needle’s position, whereas conventional CT guidance takes 1 picture at a time.)

This article was written by Melanie Witt, RN, CPC, MA, former program manager in the Department of Coding and Nomenclature at ACOG. She is now an independent coding and documentation consultant. Her comments reflect 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.

Q I recently discovered that a nearby practice is using both the 1995 and 1997 Medicare guidelines for coding. However, it is my understanding that you have to choose one set or the other and use it exclusively. Our office uses the 1995 guidelines, and our audit form reflects that decision. Which strategy is correct?

A Both approaches are correct. According to Medicare, you are free to use either set of guidelines or take advantage of both. For example, you may change sets from one patient to the next. If you are audited by Medicare, the auditor will select the set that gives your practice the advantage and will not ask which set you utilized.

This rule was never officially included in the Medicare regulations. However, it was communicated to the former AMA president Percy Wooten, MD, by Nancy-Ann Min DeParle of the Health Care Financing Administration (HCFA). In April, 1998, she said: “I am directing carriers to continue to use both the 1995 and 1997 guidelines, whichever is more advantageous to the physician, until the revisions [to the guidelines] have been completed and there has been an adequate period of time for testing and education.”

Feel free to continue using only the 1995 guidelines. Actually the only difference between the 2 sets is the physical examination criteria.

This article was written by Melanie Witt, RN, CPC, MA, former program manager in the Department of Coding and Nomenclature at ACOG. She is now an independent coding and documentation consultant. Her comments reflect 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.

Q I recently discovered that a nearby practice is using both the 1995 and 1997 Medicare guidelines for coding. However, it is my understanding that you have to choose one set or the other and use it exclusively. Our office uses the 1995 guidelines, and our audit form reflects that decision. Which strategy is correct?

A Both approaches are correct. According to Medicare, you are free to use either set of guidelines or take advantage of both. For example, you may change sets from one patient to the next. If you are audited by Medicare, the auditor will select the set that gives your practice the advantage and will not ask which set you utilized.

This rule was never officially included in the Medicare regulations. However, it was communicated to the former AMA president Percy Wooten, MD, by Nancy-Ann Min DeParle of the Health Care Financing Administration (HCFA). In April, 1998, she said: “I am directing carriers to continue to use both the 1995 and 1997 guidelines, whichever is more advantageous to the physician, until the revisions [to the guidelines] have been completed and there has been an adequate period of time for testing and education.”

Feel free to continue using only the 1995 guidelines. Actually the only difference between the 2 sets is the physical examination criteria.

This article was written by Melanie Witt, RN, CPC, MA, former program manager in the Department of Coding and Nomenclature at ACOG. She is now an independent coding and documentation consultant. Her comments reflect 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.

Q I recently discovered that a nearby practice is using both the 1995 and 1997 Medicare guidelines for coding. However, it is my understanding that you have to choose one set or the other and use it exclusively. Our office uses the 1995 guidelines, and our audit form reflects that decision. Which strategy is correct?

A Both approaches are correct. According to Medicare, you are free to use either set of guidelines or take advantage of both. For example, you may change sets from one patient to the next. If you are audited by Medicare, the auditor will select the set that gives your practice the advantage and will not ask which set you utilized.

This rule was never officially included in the Medicare regulations. However, it was communicated to the former AMA president Percy Wooten, MD, by Nancy-Ann Min DeParle of the Health Care Financing Administration (HCFA). In April, 1998, she said: “I am directing carriers to continue to use both the 1995 and 1997 guidelines, whichever is more advantageous to the physician, until the revisions [to the guidelines] have been completed and there has been an adequate period of time for testing and education.”

Feel free to continue using only the 1995 guidelines. Actually the only difference between the 2 sets is the physical examination criteria.

This article was written by Melanie Witt, RN, CPC, MA, former program manager in the Department of Coding and Nomenclature at ACOG. She is now an independent coding and documentation consultant. Her comments reflect 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.

<huc>Q</huc> How should our practice bill for a woman who presents to the hospital for an evaluation after delivering at home? She is an established patient of one of our physicians.

<huc>A</huc> The answer depends on whether the home delivery was planned or the patient simply did not make it to the hospital in time. If planned and her physician or a collaborating nurse midwife did the delivery, use 59400 (routine obstetric care, including antepartum care, vaginal delivery [with or without episiotomy and/or forceps], and postpartum care) and do not bill separately for the postpartum evaluation in the hospital. If the patient delivered at home unintentionally, only bill for the postpartum care using 59430 for uncomplicated inpatient or outpatient visits until 6 weeks’ postpartum, or report the global code with the modifier -52 (reduced services).

This article was written by Melanie Witt, RN, CPC, MA, former program manager in the Department of Coding and Nomenclature at ACOG. She is now an independent coding and documentation consultant. Her comments reflect 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.

<huc>Q</huc> How should our practice bill for a woman who presents to the hospital for an evaluation after delivering at home? She is an established patient of one of our physicians.

<huc>A</huc> The answer depends on whether the home delivery was planned or the patient simply did not make it to the hospital in time. If planned and her physician or a collaborating nurse midwife did the delivery, use 59400 (routine obstetric care, including antepartum care, vaginal delivery [with or without episiotomy and/or forceps], and postpartum care) and do not bill separately for the postpartum evaluation in the hospital. If the patient delivered at home unintentionally, only bill for the postpartum care using 59430 for uncomplicated inpatient or outpatient visits until 6 weeks’ postpartum, or report the global code with the modifier -52 (reduced services).

This article was written by Melanie Witt, RN, CPC, MA, former program manager in the Department of Coding and Nomenclature at ACOG. She is now an independent coding and documentation consultant. Her comments reflect 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.

<huc>Q</huc> How should our practice bill for a woman who presents to the hospital for an evaluation after delivering at home? She is an established patient of one of our physicians.

<huc>A</huc> The answer depends on whether the home delivery was planned or the patient simply did not make it to the hospital in time. If planned and her physician or a collaborating nurse midwife did the delivery, use 59400 (routine obstetric care, including antepartum care, vaginal delivery [with or without episiotomy and/or forceps], and postpartum care) and do not bill separately for the postpartum evaluation in the hospital. If the patient delivered at home unintentionally, only bill for the postpartum care using 59430 for uncomplicated inpatient or outpatient visits until 6 weeks’ postpartum, or report the global code with the modifier -52 (reduced services).

This article was written by Melanie Witt, RN, CPC, MA, former program manager in the Department of Coding and Nomenclature at ACOG. She is now an independent coding and documentation consultant. Her comments reflect 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.

Hillsborough County (Md) Circuit Court—A gravida underwent induction of labor, during which shoulder dystocia was encountered. The obstetrician performed 3 different maneuvers in an attempt to release the shoulder and deliver the baby. He eventually was successful.

In suing, the parents alleged that the Ob/Gyn applied excessive lateral traction by pulling the head downward with such force that it tore the nerves in the infant’s neck, causing Erb’s palsy. In defense, the physician claimed the injury was the result of the natural expulsion forces of labor combined with non-negligent lateral traction, which was necessary for delivery.

The jury awarded the parents $1.5 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.

Hillsborough County (Md) Circuit Court—A gravida underwent induction of labor, during which shoulder dystocia was encountered. The obstetrician performed 3 different maneuvers in an attempt to release the shoulder and deliver the baby. He eventually was successful.

In suing, the parents alleged that the Ob/Gyn applied excessive lateral traction by pulling the head downward with such force that it tore the nerves in the infant’s neck, causing Erb’s palsy. In defense, the physician claimed the injury was the result of the natural expulsion forces of labor combined with non-negligent lateral traction, which was necessary for delivery.

The jury awarded the parents $1.5 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.

Hillsborough County (Md) Circuit Court—A gravida underwent induction of labor, during which shoulder dystocia was encountered. The obstetrician performed 3 different maneuvers in an attempt to release the shoulder and deliver the baby. He eventually was successful.

In suing, the parents alleged that the Ob/Gyn applied excessive lateral traction by pulling the head downward with such force that it tore the nerves in the infant’s neck, causing Erb’s palsy. In defense, the physician claimed the injury was the result of the natural expulsion forces of labor combined with non-negligent lateral traction, which was necessary for delivery.

The jury awarded the parents $1.5 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.