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Re: OB: Coding dilemma From: Dr Eberhard Lisse (el@lisse.NA) Thu Jan 26 21:12:10 2006 Messages sorted by: [ date ][ thread ][ subject ][ author ] Next message: Dr Eberhard Lisse: "Re: OB U/S training?" Previous message: Grace Loehr: "Re: OB U/S training?" In reply to: Garry E. Siegel, M.D.: "OB: Coding dilemma" Next in thread: rmodugno@aol.com: "Re: OB: Coding dilemma" Reply: rmodugno@aol.com: "Re: OB: Coding dilemma" Reply: rmodugno@aol.com: "Re: OB: Coding dilemma" I just walked through the maternity ward of the State Hospital (public hospital, NHS type) to my way to the post natal ward to see my private patient, when I noticed a patient fitting post partum. The midwives asked me to help so we rescuscitated the patient successfully. I then proceeded to the post natal ward, when, on the other side of the corridor, I was asked by the next midwive to help, because a 26 week (mainly) unbooked primigravida with twins, footling breech and vertex, was fully dilated and pushing with te cord prolapsed (nd having been replaced by the midwife). Delivered the first very tiny baby and for the first time in my carreer the heads locked. Waited for the contraction to finish and managed to convince the patient not to push, while I displaced the second head upwards so release the entrapped, deflexed head so much I could get to the mouth to deliver. Poor Apgrar of course, but the Pediatric Intern had some Muti and the baby was breathing when I left, eventually. Second baby a bit bigger, Apgar bit better, and I told the Intern to concentrate on this one until her Resident arrived. Probably around 1 kg and they intubated and took to ICU. I would like to hear some opinions about whether you guys consider the first case enough of an emergency to warrant the immediate arrival of a Resident (when requested by an outside Specialist) to take over the patient or if you feel that 45 minutes is appropriate? And in the second case, since the presentations were known whether you (even Bernard :-)-O) would have considered a C/S (6 hours earlier, on admission)? greetings, el -- Dr. Eberhard W. Lisse \ / Obstetrician & Gynaecologist (Saar) el@lisse.NA el108-ARIN / * | Telephone: +264 81 124 6733 (cell) PO Box 8421 \ / Please send DNS/NA-NiC related e-mail Bachbrecht, Namibia ;____/ to dns-admin@na-nic.com.na on 1/26/06 9:52 PM Garry E. Siegel, M.D. said the following: > I just assisted in a twin vaginal delivery, i.e. > > My partner was the delivering doc, and he delivered #1 vertex. > > I ran the ultrasound and unsuccessfully attempted a version. > > Ultimately, the second baby was a breech extraction in which I gloved > and gowned and assisted. > > Should I bill for: > > Ultrasound? > Version with the "unsuccessful" modifier > Vaginal delivery only--assistant modifier > > I really can't come up with a better way, and I bet the above is going > to be denied anyway. > > Garry > > -- > Garry E. Siegel, M.D. > Private Practice > Roswell, GA Next message: Dr Eberhard Lisse: "Re: OB U/S training?" Previous message: Grace Loehr: "Re: OB U/S training?" In reply to: Garry E. Siegel, M.D.: "OB: Coding dilemma" Next in thread: rmodugno@aol.com: "Re: OB: Coding dilemma" Reply: rmodugno@aol.com: "Re: OB: Coding dilemma" Reply: rmodugno@aol.com: "Re: OB: Coding dilemma"

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