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Posted By Mary Peabody on 02-20-2020, 14:45:31 in Ob-Gyn
Hello Melanie

Would you report the D & D with 59160 and the cervical laceration repair with 57720? or should the repair be reported with 12041 since it was only 2cm laceration?

the patient was taken back to the OR a week later and the repair was performed back a different physicain

Preoperative Diagnoses:
1. Delayed PPH (2w PP)
2. h/o PreE w/ severe features by BPs
 
Postoperative Diagnoses:
1. Same
2. Cervical laceration
Findings:
- Preop U/S with ~4cm of fundal clot, no flow
- Postop U/S with thin endometrial stripe
- Cervix with 2cm laceration between 1 and 2 o clock, repaired
Procedure: Risks/benefits/alternatives were discussed and consents were signed. Patient was placed in lithotomy position. A graves speculum was placed and the cervix visualized. The cervix was cleaned with betadine x3. The anterior lip was injected with buffered 0.5%lidocaine with vasopression. A single tooth tenaculum was placed on the anterior lip. An additional 35 ml of lidocaine solution was then injected into the cervix for a paracervical block. At this time, a 8mm canula was advanced under ultrasound guidance. The uterus was significantly anteverted so therefore traction was placed on the tenaculum, however this resulted in the tenaculum pulling through and creating small laceration on the anterior lip of the cervix. The procedure was continued however the uterus continued to fill with blood despite multiple passes. Metherine IM and Pitocin IV were given. Sharp curettage performed. Bladder was empty with foley catheter. Another final MUA was performed. At this time, 30cc intrauterine foley balloon was placed.Uterine bleeding improved however mosels could not help with cervical laceration.
 
Given persistance of cervical laceration, pt transferred to OR for evaluation. She was placed in lithotomy position and another time out performed. Anesthesia was further established. The cervix was visualized with vaginal retractors. Cervical laceration was repair with 3-0 vicryl on a CT-1. Excellent hemostasis noted. Uterine foley was deflated. Bleeding continued to be stable. All instruments removed.
Surgical counts correct.
Comments (1)
Posted By Melanie Witt on 02-20-2020, 17:23:01
So this was an OB curettage case? Then I am confused as the op note indicates the repair of the cervix took place at the same time but in the OR, and the person who created the laceration will have to fix it with no additional charge. You have indicated a 2 week span between the D&C and the laceration repair, but that is not what your note indicates. The integumentary code, in any case, is not appropriate as it is the cervix, not skin, and the closest code would be 57720.
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