Case Study

The provider performance data for the Obstetric Service at Community Hospital of the West are provided in figure 14.3. Figure 14.4 gives an example of a physician profile for an individual physician, Dr. Jones. The physician index summary for Dr. Doe, an OB/GYN physician on the medical staff, is provided in figure 14.5. Using the physician index summary, students should complete the utilization and outcome sections of the profile in figure 14.6. Information on Dr. Doe's data is listed in the performance review, data quality, risk and safety management, and meeting attendance sections of the profile.

Finally, compare Dr. Doe's performance with the performance of the rest of the physicians on the Obstetric Service. (See figure 14.3.)

Steps to Success: Developing Staff and Human Resources 285 Figure 14.4. Physician profile for Dr. Jones (Continued) For Completion by Service Chair or Credentials Committee Chair CATEGORY YES NO Comments: Has the applicant been considered for or subject to disciplinary action since last reappointment? Have the applicant's privileges or staff appointment been suspended, revoked, or diminished in any way, either voluntary or involuntary, since last reappointment? Are there any currently pending challenges to any licensure or registration or the voluntary relinquishment of such? Are there any physical or behavioral conditions or limitations? Has the applicant exhibited satisfactory professional performance? APPROVALS: APPROVED? REVIEWER SIGNATURE YES NO DATE Service Chair Credentials Chairnysician index summary for Dr. Doe (Continued) Patient Discharge Final Age LOS Status Diagnosis Diagnosis Text Final N838 Procedure Other noninflammatory disorders of ovary, fallopian Procedure Text tube and broad ligament OUT7OZZ N830 Resection of bilateral fallopian tubes, open approach Follicular cyst of ovary 290 Chapter 14 Developing S N9489 Other specified conditions associated with female genital organs and menstrual cycle 33 1 Home 0328XXO Maternal care for other malpresentation of fetus, not applicable or unspecified 10907ZC Drainage of amniotic fluid, therapeutic from products of Z370 Single live birth conception, via natural or artificial opening 0730 Retained placenta without hemorrhage 10EOXZZ 0481 Delivery of products of conception, external approach Prolonged pregnancy OW8NXZZ Division of female perineum, external approach 10D10Z1 Extraction of products of conception, retained, via natural or artificial approach 22 2 Home 06981XO Labor and delivery complicated by cord around neck, 10EOXZZ Delivery of products of conception, external approach without compression, not applicable or unspecified Z370 Single live birth 10907ZC Drainage of amniotic fluid, therapeutic from products of conception, via natural or artificial opening OW8NXZZ Division of female perineum, external approach 25 2 Home 0328XXO Maternal care for other malpresentation of fetus, not applicable or unspecified Division of female perineum, external approach Z370 Single live birth OW8NXZZ 10EOXZZ Delivery of products of conception, external approach 3E033VJ Introduction of other hormone into peripheral vein, percutaneous approach 10907ZC Drainage of amniotic fluid, therapeutic from products of conception, via natural or artificial opening 10EOXZZ Delivery of products of conception, external approach Second-degree perineal laceration during delivery Repair perineum subcutaneous tissue and fascia, open 31 2 Home 0701 OJQBOZZ Single live birth approach Z370 Drainage of amniotic fluid, therapeutic from products of 10903ZC conception, percutaneous approach Resection of uterus, open approach OUT9OZZ Resection of cervix, open approach Endometriosis of fallopian tube OUTCOZZ Resection of bilateral ovaries, open approach 3 Home N802 40 Leiomyoma of uterus, unspecified OUT20ZZ D259 Type 2 diabetes mellitus without complication E119Plaure 14.9. Physician index summary for Dr. Doe (Continued) Patient Discharge Age LOS Final Status Diagnosis Final N393 Diagnosis Text Stress incontinence (female)(male Procedure N815 Procedure Text 81 Vaginal enterocele OTSDOZZ Reposition urethra, open approach 3 Home N814 Uterovaginal prolapse, unspecified N841 OUT9OZZ Polyp of cervis uteri Resection of uterus, open approach N840 OUTCOZZ Polyp of corpus uteri Resection of cervix, open approach D251 OUT2OZZ Intramural leiomyoma of the uterus Resection of bilateral ovaries, open approach OUT7OZZ E119 Resection of bilateral fallopian tubes, open approach Type 2 diabetes mellitus without complication OUQGOZZ 110 Repair vagina, open approach Essential (primary) hypertension E785 Hyperlipidemia, unspecified 26 2 Home 080 Encounter for full-term uncomplicated delivery 10 EOXZZ Delivery of products of conception, external approach Z370 Single live birth 3E033VJ Introduction of other hormone into peripheral vein percutaneous approach OW8NXZZ Division of female perineum, external approach 18 Home 0701 Second-degree perineal laceration during delivery OJQBOZZ Repair perineum subcutaneous tissue and fascia, open approach 099333 Smoking (tobacco) complicating pregnancy, third trimester 10EOXZZ Delivery of products of conception, external approach Z370 Single live birth OUT9OZZ Resection of uterus, open approach 72 3 Home C541 Malignant neoplasm of endometrium Resection of cervix, open approach E039 Hypothyroidism, unspecified OUTCOZZ Resection of bilateral ovaries, open approach N8320 Unspecified ovarian cysts OUT2OZZ OUT7OZZ Resection of bilateral fallopian tubes, open approach R823 Hemoglobinuria 07BCOZZ Excision of pelvis lymphatic, open approach OUSGOZZ Reposition vagina, open approach Prolapse of vaginal vault after hysterectomy Steps to Success: Developing Staff and Human Resources 295 Home N993 OUT9OZZ Resection of uterus. open approach 38 3 Endometriosis of uterus 3 Resection of cervix, open approach 50 Home N800 Iron deficiency anemia secondary to blood loss (chronic) OUTCOZZ D500 OUT20ZZ Resection of bilateral ovaries, open approach N802 Endometriosis of fallopian tube OUT7OZZ Resection of bilateral fallopian tubes, open approach N801 Endometriosis of ovary OTSDOZZ Reposition urethra, open approach N393 Stress Incontinence (female)(male) Excessive and frequent menstration with regular cycle N920 D251 Intramural leiomyoma of the uterus Inflammatory disease of cervix uteri N72 Endometriosis of pelvic peritoneum N803Figure 14.5. Physician index summary for Dr. Doe (Continued) Patient Discharge Age LOS Final Status Diagnosis Diagnosis Text Final N736 Procedure 32 3 Female pelvic peritoneal adhesions (postinfective) Procedure Text Home 0321XXO OUTTOZZ Maternal care for breech presentation, not applicable or Resection of bilateral fallopian tubes, open approach unspecified 10DOOZ1 0745 Extraction of products of conception, low cervical, open Spinal and epidural anesthesia-induced headache approach during labor and delivery 3EOS3GC Introduction of other therapeutic substance into epidural 099283 Endocrine, nutritional and metabolic diseases space, percutaneous approach complicating pregnancy, third trimester E039 Hypothyroidism, unspecified Z370 Single live birth 81 4 Home N993 Prolapse of vaginal vault after hysterectomy OUQGOZZ Repair vagina, open approach J9811 Atelectasis OJQCOZZ Repair pelvic region subcutaneous tissue and fascia open approach N393 Stress incontinence (female)(male) OTSDOZZ Reposition urethra, open approach 110 Essential (primary) hypertension E039 Hypothyroidism, unspecified M129 Arthropathy, unspecified R112 Nausea with vomiting, unspecified K5900 Constipation, unspecified Maternal care for transverse and oblique lie, not 10907ZC Drainage of amniotic fluid, therapeutic from products of 28 2 Home 0322XXO conception, via natural or artificial opening applicable or unspecified 10EOXZZ Delivery of products of conception, external approach 0722 Delayed and secondary postpartum hemorrhage Repair vulva, external approach 07182 Other specified trauma to perineum and vulva OUQMXZZ OW8NXZZ Division of female perineum, external approach 2370 Single live birth 10D0726 Extraction of products of conception, vacuum, via natural or artificial opening OUT9OZZ Resection of uterus, open approach C541 Malignant neoplasm of endometrium Resection of cervix, open approach 3 Home OUTCOZZ 54 Nonrheumatic mitral (valve) insufficiency 1340 OUT2OZZ Resection of bilateral ovaries, open approach N812 Incomplete uterovaginal prolapse OUT7OZZ Resection of bilateral fallopian tubes, open approach N393 Stress incontinence (female)(male) N950 Postmenopausal bleeding OUQGOZZ Repair vagina, open approach Endometriosis of ovary N801284 Chapter 14 Developing Staff and Human Resources ... .. Figure 14.4. Physician profile for Dr. Jones COMMUNITY HOSPITAL OF THE WEST PROVIDER PERFORMANCE REVIEW SUMMARY FOR REAPPOINTMENT PROVIDER Bob Jones, M.D Profile Time Frame SERVICE OB/GYN From: 1/1 /yyyy CATEGORY Active To: 12/31/yyyy UTILIZATION: Discharges 175 Procedures Patient Days 540 Pts with prev C-Sections Deliveries 145 VBACS IN C-Sections N Blood Given OUTCOMES: Category % Comments: C-Section Rate 15.2% VBAC Rate 20.0% Hospital-acquired inf Rate 1.71% Surgical Wound Inf Rate 3.8% Mortality Rate 0.57% PERFORMANCE REVIEW: Category # Reviewed # Appropriate/% Comments: Surgical/Inv/Noninvasive Procedures 5/83.3% Medication Use 8/80% Blood Use 2/100% Utilization Management 18/100% Other Peer Review N/A DATA QUALITY: Data Quality Monitoring Comments: Delinquency (>21 days) 12.5% m in Suspensions 2.60% RISK/SAFETY MANAGEMENT Incidents reported by other Comments: professionals or Administration 2/100% Litigation 4.20% MEETING ATTENDANCE: Medical Staff Meetings 100% Comments: Committee Meetings 80%Steps to Success: Developing Staff and Human Resources 283 Case Study.. 4494945405 The prov provider performance data for the Obstetric Service at Community Hospital of the West are provided in figure 14.3. Figure 14.4 gives an example of a physician profile for an individual physi- cian, Dr. Jones. The physician index summary for Dr. Doe, an OB/GYN physician on the medical staff, is provided in figure 14.5. Using the physician index summary, students should complete the utilization and outcome sections of the profile in figure 14.6. Information on Dr. Doe's data is listed in the performance review, data quality, risk and safety management, and meeting attendance sections of the profile Figure 14.3. Physician profile for OB/GYN group COMMUNITY HOSPITAL OF THE WEST PROVIDER PERFORMANCE REVIEW SUMMARY FOR REAPPOINTMENT PROVIDER OB/GYN GROUP Profile Time Frame: SERVICE OB/GYN From: CATEGORY 1/1/yyyy Active To: 12/31/ yyyy UTILIZATION: Discharges 1,400 Procedures 598 Patient Days 5 , 143 Pts with prev C-Sections 346 Deliveries 1,187 VBACS 89 C-Sections 13 Blood Given 25 OUTCOMES: Category Comments: C-Section Rate 137 11.5% VBAC Rate 25.7% Hospital-acquired inf Rate 1.5% Surgical Wound Inf Rate 0.84% Mortality Rate 0.07% PERFORMANCE REVIEW: Category # Reviewed # Appropriate/% Comments: Surgical/Inv/Noninvasive Procedures 60 58/96.7% Medication Use 139/99.3% Blood Use 25/100% Utilization Management 140 135/95.7% Other Peer Review 140 130/92.8% Clinical Pert. DATA QUALITY: Comments Data Quality Monitoring Delinquency (>21 days) 7.70% 2.60% Suspensions RISK/SAFETY MANAGEMENT: Comments: Incidents reported by other 2/100% professionals or Administration 0.07% Litigation MEETING ATTENDANCE; Comments: 93% Medical Staff Meetings 85% Committee Meetings Finally, compare Dr. Doe's performance with the performance of the rest of the physicians on the Obstetric Service. (See figure 14.3.)Steps to Success: Developing Staff and Human Resources 297 coure 14.6. Blank physician profile for case study COMMUNITY HOSPITAL OF THE WEST PROVIDER PROVIDER PERFORMANCE REVIEW SUMMARY FOR REAPPOINTMENT SERVICE CATEGORY Profile Time Frame: From: To: Discharges UTILIZATION Procedures Patient Days Pts with prev C-Sections Deliveries C-Sections VBACS Blood Given OW8NXZZ Division of female perineum, external approach OUTCOMES Category # % C-Section Rate Comments: VBAC Rate Hospital-acquired inf Rate Surgical Wound Inf Rate Mortality Rate PERFORMANCE REVIEW: Category # Reviewed # Appropriate/% Comments: Surgical/Inv/Noninvasive Procedures 5/83.3% Medication Use 8/80% O ON Blood Use 2/100% Utilization Management 18/100% Other Peer Review N/A DATA QUALITY: Data Quality Monitoring Comments: Delinquency (>21 days) 8.0% N T Suspensions 1.00% RISK/SAFETY MANAGEMENT: Comments: Incidents reported by other professionals or Administration N/A N/A Litigation MEETING ATTENDANCE: 100% Comments: Medical Staff Meetings 80% Committee MeetingsFigure 14.5. Physician index summary for Dr. Doe (Continued) Patient Discharge 294 Final Age LOS Status Diagnosis Final 41 Diagnosis Text 2 Home 099810 Procedure Abnormal glucose complicating pregnancy Procedure Text 10907ZC Drainage of amniotic fluid, therapeutic from products of Z370 Single live birth conception, via natural or artificial opening 06014XO 10 EOXZZ Preterm labor third trimester with preterm delivery third OW8NXZZ Delivery of products of conception, external approach trimester, not applicable or unspecified Division of female perineum, external approach 0403XXO Polyhydramnios, third trimester, not applicable or unspecified 10D07Z3 Extraction of products of conception, low forceps, via Chapter 14 Developing Staff and Human Resources 009513 natural or artificial opening Supervision of elderly primigravida, third trimester 07589 Other specified complications of labor and delivery R1110 Vomiting, unspecified 0621 Secondary uterine inertia 04393 Unspecified placental disorder, third trimester 59 3 Home N812 Incomplete uterovaginal prolapse OUT97ZZ Resection of uterus, via natural or articial opening D252 Subserosal leiomyoma of uterus OUQGOZZ Repair vagina, open approach N840 Polyp of corpus uteri OJQCOZZ Repair pelvic region subcutaneous tissue and fascia open approach E049 Nontoxic goiter, unspecified OT9BOOZ Drainage of bladder with drainage device, open approach 33 0640XXO Obstructed labor due to incomplete rotation of fetal 10907ZC Drainage of amniotic fluid, therapeutic from products of Home head, not applicable or unspecified conception, via natural or artificial opening 0700 First-degree perineal laceration during delivery OHQ9XZZ Repair perineum skin, external approach Delivery of products of conception, external approach Z370 Single live birth 10EOXZZ Maternal care for other malpresentation of fetus, not OW8 NXZZ Division of female perineum, external approach 30 2 Home 0328XXO applicable or unspecified 10D0723 Extraction of products of conception, low forceps via natural or artificial opening 10EOXZZ Delivery of products of conception, external approach 0752 Pyrexia during labor, not elsewhere classified OUJD7ZZ Inspection of uterus and cervix, via natural or artificial 03421 Maternal care for scar from previous cesarean delivery opening Z370 Single live birth OUQGOZZ Repair vagina, open approach N8110 Cystocele unspecified Repair pelvic region subcutaneous tissue and fascia, OJQCOZZ 67 3 Home open approach N816 RectoceleFigure 14.5. Physician index summary for Dr. Doe (Continued) Patient Discharge Final Age LOS Status Diagnosis Final Diagnosis Text Procedure N800 Endometriosis of uterus Procedure Text OTSDOZZ E669 Obesity, unspecified Reposition urethra, open approach T502X5S Adverse effect of carbonic-anhydrase inhibitors, benzothiazepiner diuretics, sequela 19 Home 06014XO Preterm labor third trimester with preterm delivery third 10907ZC trimester, not applicable or unspecified Drainage of amniotic fluid, therapeutic from products of conception, via natural or artificial opening Z370 Single live birth 10EOXZZ Delivery of products of conception, external approach 0411030 Infection of amniotic sac and membranes, unspecified, OW8 NXZZ Division of female perineum, external approach third trimester, not applicable or unspecified 37 3 Home 0321XXO Maternal care for breech presentation, not applicable or 10DOOZ1 Extraction of products of conception, low cervical, open unspecified approach Z370 Single live birth 24 2 Home 0702 Third-degree perineal laceration during delivery OKQMOZZ Repair perineum muscle, open approach 06981XO Labor and delivery complicated by cord around neck, ODQROZZ Repair anal sphincter, open approach without compression, not applicable or unspecified Z370 Single live birth OW8NXZZ Division of female perineum, external approach 21 2 Home 080 Encounter for full-term uncomplicated delivery 10EOXZZ Delivery of products of conception, external approach Z370 Single live birth 10907ZC Drainage of amniotic fluid, therapeutic from products of conception, via natural or artificial opening 3E033VJ Introduction of other hormone into peripheral vein, percutaneous approach Supervision of pregnancy with grand multiparity, third 10EOXZZ Delivery of products of conception, external approach 39 2 Home 00943 trimester 009523 Supervision of elderly multigravida, third trimester 0700 First-degree perineal laceration during delivery Z370 Single live birth Z302 Encounter for sterilization OW8NXZZ Division of female perineum, external approach Encounter for full-term uncomplicated delivery Delivery of products of conception, external approach 1 Home 080 10EOXZZ 33 Drainage of amniotic fluid, therapeutic from products of Z370 Single live birth 10907ZC conception, via natural of artificial openingFigure 14.5. Physician index summary for Dr. Doe Patient Discharge Final Age Os Status Fina Diagnosis Diagnosis Text Procedure Procedure Text 52 3 Home N920 Excessive and frequent menstration with regular cycle OUT9OZZ Resection of uterus, open approach 1428 Other cardiomyopathyes OUTCOZZ Resection of cervix, open approach 110 Essential (primary) hypertension OUT2OZZ Resection of bilateral ovaries, open approach E119 Type 2 diabetes mellitus without complication OUT7OZZ Resection of bilateral fallopian tubes, open approach D251 Intramural leiomyoma of the uterus 29 4 Home 0334XXO Maternal care for disproportion of mixed maternal and 10DOOZ1 Extraction of products of conception, low cervical, open fetal origin, not applicable or unspecified approach 0621 Secondary uterine inertia OUTCZZZ Dilation of cervix, via natural or artificial opening 0411030 Infection of amniotic sac and membranes, unspecified, 10907ZC Drainage of amniotic fluid, therapeutic from products of third trimester, not applicable or unspecified conception, via natural or artificial opening 0481 Prolonged pregnancy Z370 Single live birth rces 27 2 Home 03421 Maternal care for scar from previous cesarean delivery OW8NXZZ Division of female perineum, external approach Z370 Single live birth 10 EOXZZ Delivery of products of conception, external approach 10907ZC Drainage of amniotic fluid, therapeutic from products of conception, via natural or artificial opening 79 4 Home N993 Prolapse of vaginal vault after hysterectomy OUSGOZZ Reposition vagina, open approach N9989 Other postprocedural complications and disorders of ODNGOZZ Release left large intestine, open approach the genitourinary system N390 Urinary tract infection, site not specified 19589 Other postprocedural complications and disorders of respiratory system, not elsewhere classified J9811 Atelectasis N3941 Urge incontinence Y838 Other surgical procedures as the cause of abnormal reaction of the patient, or of later complication, without mention of misadventure at the time of the procedure 110 Essential (primary) hypertension N994 Postprocedural pelvic peritoneal adhesions Extraction of products of conception, low cervical, open Maternal care for breech presentation, not applicable or 10DOOZ1 approach 25 4 Home 0321XXO unspecifiedFigure 14.5. Physician index summary for Dr. Doe (Continued) Patient Discharge Age LOS Final Status Diagnosis 22 Home Diagnosis Text Final 06981XO Procedure Labor and delivery complicated by cord around neck, Procedure Text without compression, not applicable or unspecified 10EOXZZ 2370 Delivery of products of conception, external approach Single live birth 10907ZC 099824 Drainage of amniotic fluid, therapeutic from products of conception, via natural or artificial opening 20 Streptococcus B carrier state complicating childbirth Home 042913 OW8 NXZZ Preterm premature rupture of membranes, unspecified Division of female perineum, external approach OW8 NXZZ as to length of time between rupture and onset of labor, Division of female perineum, external approach third trimester 076 Abnormality in fetal heart rate and rhythm complicating 10EOXZZ labor and delivery Delivery of products of conception, external approach 06014XO Preterm labor third trimester with preterm delivery third trimester, not applicable or unspecified 0691XXO Labor and delivery complicated by cord around neck, with compression, not applicable or unspecified 099824 Streptococcus B carrier state complicating childbirth Z370 Single live birth Maternal care for breech presentation, not applicable or 10DOOZ1 Extraction of products of conception, low cervical, open ons of sdois 34 3 Home 0321XXO approach unspecified Full-term premature rupture of membranes, unspecified OUL73ZZ Occlusion of bilateral fallopian tubes, percutaneous 04292 as to length of time between rupture and onset of labor approach 099333 Smoking (tobacco) complicating pregnancy, third trimester Z370 Single live birth Z302 Encounter for sterilization 10EOXZZ Delivery of products of conception, external approach Maternal care for other malpresentation of fetus, not 0328XXO 22 1 Home applicable or unspecified OHQ9XZZ Repair perineum skin, external approach Abnormality in fetal heart rate and rhythm complicating 076 labor and delivery 109072C Drainage of amniotic fluid, therapeutic from products of Labor and delivery complicated by cord around conception, via natural or artificial opening aff and Human Resources 293 06981XO the neck without compression, not applicable or unspecified inspection of uterus and cervix, via natural or artificial First-degree perineal laceration during delivery opening 0700 Z370 Single live birthPhysician index summary for Dr. Doe (Continued) 962 Patient Discharge Final Age Os Status Diagnosis Final Diagnosis Text Procedure 102 Pelvic and perineal pain Procedure Text E119 Type 2 diabetes mellitus without complication K449 Diaphragmatic hernia without obstruction of gangrene 28 1 Home 04103XO Oligohyramnios, third trimester, not applicable or unspecified OW8NXZZ 0752 Division of female perineum, external approach Pyrexia during labor, not elsewhere classified 10D0723 Extraction of products of conception, low forceps, via natural or artificial opening Chapter 14 Developing Staff and Human Resources 0328XXO Maternal care for other malpresentation of fetus, not 10EOXZZ applicable or unspecified Delivery of products of conception, external approach 0665 Attempted application of vacuum extractor and forceps OHQ9XZZ Repair perineum subcutaneous tissue and fascia, open approach 0701 Second-degree perineal laceration during delivery 10D10Z1 Extraction of products of conception, retained, via natural or artificial approach 06981XO Labor and delivery complicated by cord around neck, 3E033VJ Introduction of other hormone into peripheral vein, without compression, not applicable or unspecified percutaneous approach Z370 Single live birth 24 2 Home 0365930 Maternal care for other known or suspected poor fetal 3E033VJ Introduction of other hormone into peripheral vein, growth, third trimester, not applicable or unspecified percutaneous approach 0752 Pyrexia during labor, not elsewhere classified 10903ZC Drainage of amniotic fluid, therapeutic from products of conception, percutaneous approach Z302 Encounter for sterilization 10EOXZZ Delivery of products of conception, external approach 0328XXO Maternal care for other malpresentation of fetus, not OW8 NXZZ Division of female perineum, external approach applicable or unspecified Encounter for immunization OUJDZZZ Inspection of uterus and cervix, via natural or artificial opening Z23 Labor and delivery complicated by cord around neck OW8 NXZZ Division of female perineum, external approach 39 2 Home 06981XO without compression, not applicable or unspecified 3E033VJ Introduction of other hormone into peripheral vein Z370 Single live birth percutaneous approach 10EOXZZ Delivery of products of conception, external approach 10903ZC Drainage of amniotic fluid, therapeutic from products of conception, percutaneous approach 3E033VJ Introduction of other hormone into peripheral vein, 06981XO Labor and delivery complicated by cord around neck, percutaneous approach 30 1 Home without compression, not applicable or unspecified Delivery of products of conception, external approach 10EOXZZ Z370 Single live birth OW8NXZZ Division of female perineum, external approachFigure 14.5. Physician index summary for Dr. Doe (Continued) Patient Discharge Final Final Age LOS Status Diagnosis Diagnosis Text Procedure Procedure Text N800 Endometriosis of uterus OTSDOZZ Reposition urethra, open approach 288 Chapter 14 Developing S D259 Leiomyoma of uterus, unspecified OUQGOZZ Repair vagina, open approach N393 Stress incontinence (female)(male) OFT44ZZ Resection of gallbladder, percutaneous endoscopic approach N816 Rectocele 42 2 Home 03421 Maternal care for scar from previous cesarean delivery 3E033VJ Introduction of other hormone into peripheral vein, percutaneous approach Z370 Single live birth 10903ZC Drainage of amniotic fluid, therapeutic from products of conception, percutaneous approach 06981XO Labor and delivery complicated by cord around neck, 10EOXZZ Delivery of products of conception, external approach without compression, not applicable or unspecified 099810 Abnormal glucose complicating pregnancy 0329XXO Maternal care for malpresentation of fetus, unspecified, not applicable or unspecified 22 2 Home 0702 Third-degree perineal laceration during delivery OKQMOZZ Repair perineum muscle, open approach 0368930 Maternal care for other specified fetal problems, third ODQROZZ Repair anal sphincter, open approach trimester, not applicable or unspecified Z370 Single live birth 10EOXZZ Delivery of products of conception, external approach Extraction of products of conception, low cervical, open 37 14 Home 076 Abnormality in fetal heart rate and rhythm complicating 10DOOZ1 labor and delivery approach OUL73ZZ Occlusion of bilateral fallopian tubes, percutaneous 02233 Deep phlebothrombosis in pregnancy, third trimester approach 099013 Anemia complicating pregnancy, third trimester 042113 Preterm premature rupture of membranes, onset of labor more than 24 hours following rupture, third trimester 0321XXO Maternal care for breech presentation, not applicable or unspecified 06014XO Preterm labor third trimester with preterm delivery third trimester, not applicable or unspecified Supervision of elderly multigravida, third trimester 009523 Other specified pregnancy related conditions, third 026893 trimesterFigure 14.5. Physician index summary for Dr. Doe (Continued) Patient Discharge Age LOS Final Status Diagnosis Diagnosis Text Final D7589 Procedure organs Other specified diseases of blood and blood-forming Procedure Text R21 Rash and other nonspecific skin eruption Z370 Single live birth Z302 28 Encounter for sterilization Home 06981XO Labor and delivery complicated by cord around neck without compression, not applicable or unspecified OW8NXZZ Division of female perineum, external approach 0752 Pyrexia during labor, not elsewhere classified 3E033VJ Introduction of other hormone into peripheral vein, Z370 percutaneous approach Single live birth 10903ZC Drainage of amniotic fluid, therapeutic from products of conception, percutaneous approach 22 2 Home 06981XO Labor and delivery complicated by cord around neck, 10907ZC Drainage of amniotic fluid, therapeutic from products of without compression, not applicable or unspecified conception, via natural or artificial opening 0752 Pyrexia during labor, not elsewhere classified 10EOXZZ Delivery of products of conception, external approach 0701 Second-degree perineal laceration during delivery OJQBOZZ Repair perineum subcutaneous tissue and fascia, open approach Z370 Single live birth OUTCZZZ Dilation of cervix, via natural or artificial opening 42 2 Home 009523 Supervision of elderly multigravida, third trimester 10EOXZZ Delivery of products of conception, external approach Z370 Single live birth OJQBOZZ Repair perineum subcutaneous tissue and fascia, open 0701 Second-degree perineal laceration during delivery approach Postmenopausal bleeding OUT9OZZ Resection of uterus, open approach 67 3 Home N950 OUTCOZZ Resection of cervix, open approach M316 Other giant cell arteritis OUT20ZZ Resection of bilateral ovaries, open approach E860 Dehydration OUT7OZZ Resection of bilateral fallopian tubes, open approach D251 Intramural leiomyoma of the uterus ODNEOZZ Release large Intestine, ope approach N840 Polyp of corpus uteri Postprocedural pelvic peritoneal adhesions N994 Personal history of venous thrombosis and embolism Z8671 145909 Unspecified asthma, uncomplicated OUT9OZZ Resection of uterus, open approach Excessive bleeding in the premenopausal period Home N924 OUTCOZZ Resection of cervix, open approach 51 3 Iron deficiency anemia secondary to blood loss (chronic) D500 OUT20ZZ Resection of bilateral ovaries, open approach Intramural leiomyoma of the uterus D251