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Uterus and Placenta (C-section)

  1. #1
    Default Uterus and Placenta (C-section)
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    I have a case where they performed a C-section, and removed the Uterus at that time. The specimen is in one container, but the the Diagnosis includes a DX of the Placenta as well as the Uterus. Is the Placenta separately chargeable (ie 88307x2)?

    "UTERUS", (CAESAREAN HYSTERECTOMY):

    - UTERUS AND PLACENTA, 780 G, APPROPRIATE FOR GESTATION.
    - ADHERENT PLACENTA PERCRETA, EXTENDING THROUGH FULL
    THICKNESS OF LOWER ANTERIOR UTERINE WALL.

    - LOWER SEGMENT WITH FOCAL ENDOCERVICAL-TYPE LINING, NO
    ECTOCERVIX IDENTIFIED.
    - SCANTY DECIDUALIZED ENDOMETRIUM IDENTIFIED IN UPPER
    UTERINE SEGMENT.
    - MYOMETRIUM WITH FOCAL LEIOMYOMA (3.5 CM).
    - UTERINE SEROSA, HISTOLOGICALLY UNREMARKABLE.
    - NO EVIDENCE OF MALIGNANCY.

    - THREE VESSEL UMBILICAL CORD, HISTOLOGICALLY UNREMARKABLE.
    - ATTACHED MEMBRANES WITH PIGMENT LADEN MACROPHAGES.
    - ACUTE SUBCHORIONITIS, MILD.
    - VILLOUS DEVELOPMENT APPROPRIATE FOR GESTATION.
    - MULTIFOCAL INTERVILLOUS HEMATOMAS/THROMBI.
    Last edited by kate8; 08-17-2010 at 10:29 AM.

  2. #2
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    A placenta is not an integral part of a hysterectomy. You have a diagnosis for both in the report so you can unbundle the placenta. I'm assuming they were both documented grossly and microscopically. 88307 x 2 is appropriate.

    I don't know if you're going to assign separate dx codes but I would use leiomyoma for the uterus and placenta accretia for the placenta. I don't have the code book handy, but they're pretty straightforward.

  3. #3
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    Thank you! That is what I was thinking. Yes, the Placenta is described in the Gross Description as well as the Uterus, so that supports the 88307x2 codes. Just wanted to be sure since I hadn't seen any information about this in any other coding reference I have.
    Last edited by kate8; 08-17-2010 at 02:59 PM.

  4. Default
    Quote Originally Posted by whaleheadking View Post
    A placenta is not an integral part of a hysterectomy. You have a diagnosis for both in the report so you can unbundle the placenta. I'm assuming they were both documented grossly and microscopically. 88307 x 2 is appropriate.

    I don't know if you're going to assign separate dx codes but I would use leiomyoma for the uterus and placenta accretia for the placenta. I don't have the code book handy, but they're pretty straightforward.
    The primary diagnosis code for this condition, is Placenta increta and not leomyoma uterus.
    Placenta increta includes the "bieng invaded Uterus" and they are inseparable clinically and that is the reason for the procedure of cesarean Hysterectomy; therein too, you can not separate /or unbundle them because there is a code for Cesarean Hysterctomy, done at the same time. The primary diagnosis code for the procedure is NOT LEOMYOMA but Placenta percreta.
    The principal/primary diagnosis code and procedure code are accerately fitting in for.
    The leomyoma of the uterus has no impact on this particular case as the priority. It was just a coincidental finding and the removal of the uterus was for the incorporated and inseparable placenta and the uterus, which could, otherwise bring forth the mortality , if left alone..
    You can give a second third or 4th diagnosis for leomyoma and that is not the on ewe deal with now and is irrelevant at this point. The uterus is already "out' for other reasons .
    Thank you
    Last edited by preserene; 08-18-2010 at 06:37 PM.

  5. #5
    Default
    You are correct. The specimen is inseparable clinically. It is not inseparable pathologically though. Two independent diagnoses have been rendered on unlike organs by separate examinations. Pathologically, they are two specimens.

    The primary clinical diagnosis for the hysterectomy (another CPT code altogether) is placenta accretia and the leiomyomata are incidental to that if they were even considered at the time. I'm not privy to the op report and it's irrelevant to services provided in the lab. From a pathologist's point of view, the placenta accretia code is pertinent to the placenta. The real news on the uterus are the leiomyomata which provides useful information to the clinician and to the patient's medical record. Based on the documentation, I would be comfortable with 88307 x2 and I would challenge any audit that found otherwise.

    How you handle the dx coding is up to you. My colleague above and I both agree a non-neoplastic uterus was submitted for examination and diagnosis. Assigning medical necessity is your choice but pathologically speaking and based on the report, the leiomyoma carries the weight for the uterus for me in this unusually occuring compound specimen.

  6. Default
    The pathology code of this case I have already given in the thread she also gave in OBGYN.
    There was not any difference . My point in this thread is not about the pathology coding.
    I just wanted to highlight the accuracy of ICD coding in connection with the clinical status and the importance of Primary diagnosis code in this situation. I am not talking about the MR nor a word about the pathology coding for this case here in my openion .
    Even for the Pathologist the increta status of the placenta invaded into the myometrium of the uterus is a great concern to report as to the cause of the clinical picture and the procedure for which he gives more relevance too than to his coincidental presence of lyiomyoma and its report, though.

    I never said that it is inseparable once hysterectomy is done. It can be cut into pieces to see the myomas, whatever, at the operation theatre itself, if the OBGYN physician wanted to know the gross anatomy by her/himself.
    It was a percreta specimen and not acreta There is difference in thier clinical outcome and separation process also even as a specimen because it has encroached into the uterine myometrium an dthe pathologist separates not as whloe lot, as you can do it in accreta
    Thank you Bye
    Last edited by preserene; 08-18-2010 at 06:38 PM.

  7. #7
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    You gave the correct answer on the OB/GYN thread.

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