# Intaoperative consult vs cesarean assist



## AR2728 (Sep 7, 2010)

Our OBGYN practice also employs an MD who has a fellowship in OB, so she can perform C-sections. She recently performed a c-sect and called in the OBGYN due to uterine dehiscence after the baby was delivered. Following is the portion of the note that involved the OBGYN:
At this time Dr. OBGYN was consulted for intraoperative consult to assist with repair of this.The margins of the wound dehiscence were identified and lower uterine segment and wound dehiscence was repaired using 0 vicryl in a running lock fashion and then oversewed again with the same stitch until good repair of the muscle layer of the lower uterine segment was seen. There was a small bleeding vessel which were oversewed with figure of eight Caperson on the primary uterine incision repair and along the wound dehiscence repair. There was still some bleeding noted and pressure was applied while the posterior aspect of the uterine layer and abdomen was irrigated and clots removed. The uterus was then returned to the abdomen. There was still some bleeding noted and Gelfoam was put in place and pressure applied until hemostasis was noted. At this point Dr. OBGYN scrubbed out of the case. 
The OBGYN states this is Intraoperative Consult-However, Wouldn't this be billable as a c-section assist? Does the OBGYn need to be present for the complete cesarean to bill an assist?

Thanks for your time! 

April Rader


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## bonzaibex (Sep 7, 2010)

Wouldn't that depend on the OB-GYN's documentation?  Did the OB-GYN dictate a report?  If I'm reading your scenario correctly, your selection of intra-operative consult vs c-section assist would be dependent on the consulting/assisting doctor's documentation, not the primary surgeon's documentation.  

Becky, CPC


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## carol blake (Sep 7, 2010)

I agree with Becky, it's going to depend on the OBGYN's documentation.  However, many carriers do not pay for assist at surgery for c-sections, especially if it's done in a teaching hospital.  So, before you decide, check your payer rules.
Carol, CPC,RHIT


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## AR2728 (Sep 8, 2010)

I have attached a copy of the OBGYN report, please review and advise:

At the request of Dr. , I was asked to step into the operating room during her repeat cesarean section on Patient. After successful cesarean delivery and repair of
the Pfannenstiel incision, it was noticed that there seemed to be a dehiscence of the previous uterine scar partially masked by adhesions between the lower segment of the uterus and the bladder. Appropriate plains of dissection were identified as was the extent of gaping lower segment uterine tissue. The tissue was carefully elevated with Pennington clamps and repaired with O Vicryl in a running suture. This area was then oversewn with a second line of suture. Persistent oozing was noted and inspite of several episodes of application of firm pressure to the area, decision was made to apply Gelfoam to the area of oozing between the lower segment of the uterus and the bladder. At the end of this part of the procedure, the patient's normal anatomy was re-established and I
scrubbed out.
____________________________


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## AR2728 (Sep 8, 2010)

Sorry, but I had a thought:   Would it be appropriate to bill 13160 for the OBGYNs services as this is dehiscence of cesarean wound?


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