OB Fall out HELP!
We dont review OB records generally-speaking, so I could use some help.
Quality notified me of an OB fallout for an elective induction prior to 39weeks. This patient had a breech baby and was scheduled for a C/S at 39wks. Then she went into labor and her water broke we we ended up doing the C/S at 38 wks. This is now coming across as a fallout though we know clinically this is standard of care. Currently we have:
1. O32.1XX0 -maternal care for breech presentation
Z37.0 -singel live birth
Z3A.38 -38 wks gestation
10D00Z1 -C/S
Is there something missing that should have been coded that would have captured the fact that this women was in labor and had SROM or is this just a fallout we have to eat?
thanks so much!!
Katy Good
Quality notified me of an OB fallout for an elective induction prior to 39weeks. This patient had a breech baby and was scheduled for a C/S at 39wks. Then she went into labor and her water broke we we ended up doing the C/S at 38 wks. This is now coming across as a fallout though we know clinically this is standard of care. Currently we have:
1. O32.1XX0 -maternal care for breech presentation
Z37.0 -singel live birth
Z3A.38 -38 wks gestation
10D00Z1 -C/S
Is there something missing that should have been coded that would have captured the fact that this women was in labor and had SROM or is this just a fallout we have to eat?
thanks so much!!
Katy Good
Comments
Hi Katy,
I looked at TJC's exclusion and breech is on the contraindication for vag delivery. Not sure if the code for spontaneous labor with planned c/s would get it excluded or not. From what I am reading it looks like they took SROM off of the list of excluded codes. Unstable lie is on there, but the MD would have to document that the infant kept changing positions.
Have the Quality folks reached out to the Core Measure folks to discuss this one?
Curious to know how this one turns out. Most of ours don't fall out because they are done for maternal or fetal issues...sorry I'm not much help.
Jeff
thanks so much for the response. yes, vaginal delivery is excluded d/t breech presentation. I think that the issue is that this 'appears' from the coding summery like the C/S was performed early at 38 wks without indication. Thers nothing to show that the women was in labor or her water broke (reasons for the earlier that usual C/S). I discussed with our coding manager and she says the coding is correct but i wanted to double check ;-).
Our quality nurse said she did find that a rate of early-term elective delivery rate of 2-4% is normal and for this reason Joint commission does not support the CMS benchmard of 0% for PC-01 for VBP. So she thinks this is probably one of the cases where theres nothing we can do. I am just hesitant to accept that.....
https://www.jointcommission.org/assets/1/6/Background_and_Explanation_of_Measure_Construct_for_PC-0l.pdf
Yes, there are a few that you just have to sometimes "eat" but it's aggravating for sure!
Jeff