The gentlebirth.org website is provided courtesy of
Ronnie Falcao, LM MS, a homebirth midwife in Mountain View, CA
This brief but well-referenced post analyzes cesarean rates relative to differences in maternal diagnoses or pregnancy complexity. On average, the likelihood of cesarean delivery for an individual woman varied between 19 and 48 percent across hospitals.”
Birth attendants often claim that their high cesarean rate is due to their clientele - that they provide care for a lot of high-risk clients. This analysis shows that:
Among lower risk women, likelihood of cesarean delivery varied between 8 and 32 percent across hospitals.
Among higher risk women, likelihood of cesarean delivery varied between 56 and 92 percent across hospitals.
Hospital variability did not decrease after adjusting for patient diagnoses, socio-demographics, and hospital characteristics.
This shows that practice variation in cesarean rates is real, substantive, and not just a reflection of the mother’s risk level.
Tips for Choosing a Care Provider - great overview! from Henci Goer
Here's what Viacord says about billing for cord blood collection:
Submit the claim to your patient's insurance using CPT 59899. Use the ICD-9 code V59.02 (stem cell donor).
And here are some additional tips:
Block 19: (Enter a concise description of the procedure billed with
the unlisted CPT code. Attach documentation as described below.)
Umbilical cord blood-derived stem cell harvesting (see attached)
Block 21 Enter the appropriate ICD-9-CM diagnosis code(s) to accurately
represent the patient's condition. Some examples includes the following:
V59.02—stem cell donor
V16.6—family history of leukemia
V 10.60—leukemia, unspecified (for persons with potential health hazards related to family history of leukemia)
The codes listed above represent possible coding options and are
neither exhaustive nor appropriate in all cases. It always is the provider's
responsibility to determine and submit appropriate code(s) for the patient's
Block 24, Column D:
Enter the appropriate CPT code for umbilical cord blood-derived stem cell harvesting. Since there is no CPT code that accurately describes this procedure, we suggest using the following unlisted CPT code:
59899—unlisted procedure, maternity care and delivery
Another unlisted CPT coding option might be the following:
38999—unlisted procedure, hemic or lymphatic system
As with any unclassified code, physicians should submit a paper claim and attach supporting documentation that provides a description of the collection procedure, including a detailed breakdown of the steps involved, and the purpose of the procedure. Several payers have indicated that this claim can be separate from the electronic claim for the actual delivery so that payment for the delivery will not be delayed while a determination is being made. (Sample supporting documentation can be provided upon request.)
The codes listed above represent possible coding options. It always
is the provider's responsibility to determine and submit appropriate codes
for the services rendered.
And here's the accompanying letter they suggest:
Re: Umbilical Cord Blood-Derived Stem Cell Harvesting To Whom It May Concern:
We are submitting this claim for an unlisted Current Procedural Terminology (CPT) code for the collection of umbilical cord blood following the delivery of a newborn for potential future use in stem cell transplantation procedures. Umbilical cord blood-derived stem cell harvesting is a service that falls outside the scope of routine delivery care. There currently is no CPT code specific to this procedure; therefore, we believe that the unlisted CPT code included on this claim encompasses the procedure with the following explanation.
Umbilical cord blood, like bone marrow, is rich in stem cells — the building blocks of the blood and immune system. Therefore, umbilical cord blood also has significant medical value and lifesaving potential. There have been over 2,000 transplants performed worldwide using umbilical cord blood-derived stem cells. Umbilical cord blood offers several advantages as a stem cell source for example, umbilical cord blood is often more compatible than bone marrow when used in transplants, especially within the family, creating less chance of rejection.
Today, stem cells collected from a newborn's umbilical cord at birth are being used in the treatment of nearly 50 malignant and non-malignant diseases, including cancers such as leukemia, as well as genetic diseases, blood disorders, and immune deficiencies. Additionally, researchers are now looking to umbilical cord blood stem cells to treat stroke, diabetes, muscular dystrophy, and heart disease, to name only a few conditions.
This particular patient's umbilical cord blood is being preserved with Viacord, a reputable and accredited private cord blood bank, whose parent company ViaCell, Inc. is actively involved in researching clinical applications for stem cells. Viacord cord blood units have been used in nine umbilical cord blood stem cell transplants to date, all of which have resulted in successful engraftment.
The timing of umbilical cord blood collection is very important, as the only opportunity to preserve an individual's cord blood is at the time of birth. Viacord’ s procedure protocol begins with a collection kit (i.e., sterile needle, sterile blood bag, sterile syringe, tubing, etc.). The collection takes place as soon as possible following the separation of the infant from the umbilical cord and prior to the delivery of the placenta. Thirty- five milliliters of acid citrate dextrose (ACD) anticoagulant is added to the Y-port of the collection bag prior to the collection. The umbilical cord is double clamped 3 to 5 centimeters above the umbilicus and is transected between clamps. A 4- to 8-inch area of the umbilical cord is scrubbed with providone-iodine for 10 seconds and is then left to stand for 5 seconds. The needle is connected to a segment of tubing leading into a contiguous receiving bag. The needle is introduced into the umbilical vein, the blood bag is lowered and the blood flows by gravity into the bag. When the blood flow stops, the needle is removed from the umbilical cord and the placenta is delivered as per hospital protocol.
The CPT code that most closely approximates this procedure is CPT 38231 (blood-derived peripheral stem cell harvesting for transplantation, per collection). However, because the descriptor for CPT 38231 does not explicitly address umbilical cord blood, we have elected to use an unlisted CPT code.
If you require more clarification or have any questions regarding this
claim, please feel free to contact me. Sincerely,
Physician’s Name: ____________________ Mother’s Name: ____________________
Physician’s Phone Number: ____________ Insurance ID Number: ____________
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