debellis59
Networker
Hi All:
The note below is from a postpartum laceration repair with ongoing hemorrhage. I am considering that this would still be just 59300, but am not sure. If there is more I can code here, I'd love to be able to give my provider her due credit. It's a bit of a lengthy note, so I do apologize for that. At the very least with the JADA placement and curettage, can I use a 22 modifier? Any help is appreciated.
thank you.
Briefly, G1P0 admitted on 7/10 at 39w4d for IOL with A1GDM
GBS POS
Cervical ripening with misoprostol x 3, AROM and then augmentation with Pitocin
Patient progressed in labor to complete dilation at 0923 and began pushing at 0949
She delivered via SVD with the CNM team at 1201
I was called in to evaluate the perineal laceration and found that it did not meet criteria for a 3rd degree laceration
At that time, bleeding was adequately controlled with postpartum oxytocin and I left the room
I was called back into the room for ongoing vaginal bleeding that was not controlled with TXA and Methergine administration
I performed a uterine sweep and removed blood clots from the cavity
The pitocin dose was increased and misoprostol 400 mcg buccal was administered
This led to improved firming of the uterus initially
I began to repair the perineal, vaginal laceration at the request of the CNM team
The laceration was also bleeding rather briskly and the vaginal epithelium was extremely friable
Which made the repair particularly challenging
As hemostasis was achieved vaginally, there was a return of uterine bleeding
On another manual sweep a collection of clot was extracted and the uterus was not well contracted
I performed a banjo curettage at bedside to remove residual clot and assure no retained placental tissue and called for the JADA device when the uterus was noted to continue to be moderately atonic
The Jada device was placed immediately after removing all intrauterine clot as per the manufacturer's directions
The balloon was seated outside of the cervix and filled to 120 cc
Suction to 80-90 mmHg was begun with return of blood into the tubing
There was no bleeding around the Jada
Attention was then returned to the vagina and perineum
It was noted that the prior sutures had been disrupted by the need for manual uterine evaluation and the tissue was bleeding
A second dose of TXA was administered as it had been over 30 mins since the first
The vagina and the perineum were then carefully reapproximated in layers with 3.0 and 2.0 vicryl suture in layers.
A QBL was obtained and noted to be just over 1300 cc
CBC and coags were drawn due to ongoing oozing from the vaginal tissue
The decision was made to call for 1 unit of PRBCs for transfusion after we discussed the bleeding and associated risks with bleeding as well as blood transfusion with the patient via the interpretor.
The patient agreed to a transfusion
After completion of the vaginal and perineal repair, gentle pressure was held with laparotomy sponges and this did result in decreased bleeding
I then placed a lubricated vaginal packing into the vagina and tied the distal end to the Jada device with the plan to leave them both in place until removal of the Jada was deemed appropriate.
Total QBL 1310 during the repair = 1300 (excluding blood in Jada tubing)
A dose of Ancef 2 grams was administered for prophylaxis
A foley catheter was reinserted
The epidural was left running with SCDs in place
The patient was made NPO except clears until the Jada was deemed to be adequately controlling her bleeding.
The note below is from a postpartum laceration repair with ongoing hemorrhage. I am considering that this would still be just 59300, but am not sure. If there is more I can code here, I'd love to be able to give my provider her due credit. It's a bit of a lengthy note, so I do apologize for that. At the very least with the JADA placement and curettage, can I use a 22 modifier? Any help is appreciated.
thank you.
Briefly, G1P0 admitted on 7/10 at 39w4d for IOL with A1GDM
GBS POS
Cervical ripening with misoprostol x 3, AROM and then augmentation with Pitocin
Patient progressed in labor to complete dilation at 0923 and began pushing at 0949
She delivered via SVD with the CNM team at 1201
I was called in to evaluate the perineal laceration and found that it did not meet criteria for a 3rd degree laceration
At that time, bleeding was adequately controlled with postpartum oxytocin and I left the room
I was called back into the room for ongoing vaginal bleeding that was not controlled with TXA and Methergine administration
I performed a uterine sweep and removed blood clots from the cavity
The pitocin dose was increased and misoprostol 400 mcg buccal was administered
This led to improved firming of the uterus initially
I began to repair the perineal, vaginal laceration at the request of the CNM team
The laceration was also bleeding rather briskly and the vaginal epithelium was extremely friable
Which made the repair particularly challenging
As hemostasis was achieved vaginally, there was a return of uterine bleeding
On another manual sweep a collection of clot was extracted and the uterus was not well contracted
I performed a banjo curettage at bedside to remove residual clot and assure no retained placental tissue and called for the JADA device when the uterus was noted to continue to be moderately atonic
The Jada device was placed immediately after removing all intrauterine clot as per the manufacturer's directions
The balloon was seated outside of the cervix and filled to 120 cc
Suction to 80-90 mmHg was begun with return of blood into the tubing
There was no bleeding around the Jada
Attention was then returned to the vagina and perineum
It was noted that the prior sutures had been disrupted by the need for manual uterine evaluation and the tissue was bleeding
A second dose of TXA was administered as it had been over 30 mins since the first
The vagina and the perineum were then carefully reapproximated in layers with 3.0 and 2.0 vicryl suture in layers.
A QBL was obtained and noted to be just over 1300 cc
CBC and coags were drawn due to ongoing oozing from the vaginal tissue
The decision was made to call for 1 unit of PRBCs for transfusion after we discussed the bleeding and associated risks with bleeding as well as blood transfusion with the patient via the interpretor.
The patient agreed to a transfusion
After completion of the vaginal and perineal repair, gentle pressure was held with laparotomy sponges and this did result in decreased bleeding
I then placed a lubricated vaginal packing into the vagina and tied the distal end to the Jada device with the plan to leave them both in place until removal of the Jada was deemed appropriate.
Total QBL 1310 during the repair = 1300 (excluding blood in Jada tubing)
A dose of Ancef 2 grams was administered for prophylaxis
A foley catheter was reinserted
The epidural was left running with SCDs in place
The patient was made NPO except clears until the Jada was deemed to be adequately controlling her bleeding.