# Colpopexy, Colporrhaphy



## natashalage (Aug 18, 2020)

Hello Fellow Coders, I am new to OB/GYN and got very puzzled by this short Op note: trying to understand what was done to match CPT available. I will greatly appreciate your help! 
MD provided codes 57260 and 57282. I read the descriptions of all available CPT, I googled a lot about POP, compiled some information but nothing has helped me to find straight-forward CPT. It even does not tell me what organ has prolapsed, just the stage. It seems like the only 57282 was done. Thank you very much. in advance.


> MD put  57260 anterior and posterior colporrhaphy+ 57282 colpopexy vaginal sacrospinous aproach





> Procedure(s) and Anesthesia Type:
> * ANTERIOR COLPORRHAPHY - Anes-General =57240 but it was not done
> * CYSTOSCOPY (CYSTOURETHROSCOPY) - Anes-General = I found it is included into 57260-57265= don’t code it
> * CYSTOSCOPY, SACROSPINOUS COLPOPEXY - Anes-General  = 57282
> ...


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## natashalage (Aug 24, 2020)

natashalage said:


> Hello Fellow Coders, I am new to OB/GYN and got very puzzled by this short Op note: trying to understand what was done to match CPT available. I will greatly appreciate your help!
> MD provided codes 57260 and 57282. I read the descriptions of all available CPT, I googled a lot about POP, compiled some information but nothing has helped me to find straight-forward CPT. It even does not tell me what organ has prolapsed, just the stage. It seems like the only 57282 was done. Thank you very much. in advance.


Could anybody help me with this case, please? Thank you.


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## csperoni (Aug 25, 2020)

Not my exact area of expertise, since this is typically done by urogyn around here, but to me, it looks like 57260 & 57282 are correct.  There is no CCI edit.  To try to help, I noted *57260 related work in RED*, and *57282 related work in GREEN.*  Basically, the colporrhaphy is all the sutures placed in the vagina to repair the weakened tissue.  The colpopexy is fixing the vaginal apex into position, also with sutures.  
I do agree that is not clear WHAT was prolapsed.  Perhaps rectocele since physician noted the rectum was swept away from op field?? I am constantly having to query providers on that.  One provider had explained to me that they often do not even know what is prolapsing.  They can make an educated guess based on other findings, and location, but often do not know exactly what is causing the bulge into the vaginal canal.  
I hope at least some of this helps.  

The vaginal cuff was identified, everted and grasped with Allis clamps. The epithelium was entered sharply with Metzenbaum scissors. A 2 cm x 2 cm section of underlying _fisbromuscular tissue_ was exposed. Next the right ischial spine was identified by palpation.  The retroperitoneum was entered sharply, and a tunnel was created to the spine with blunt dissection.   Care was taken to gently sweep the rectum posterior and medial, away from the operative field.  The sacrospinous ligament and coccygeus muscle were then isolated with blunt dissection.  A Capio suture device was used to place 2 stitches of 0-PDS, through the sacrospinous ligament, 2 cm medial to the ischial spine, avoiding the pudendal neurovascular bundle.  A rectal exam confirmed proper placement, with no suture in the rectum.  The sutures were clamped and placed to the side. 

The anterior vagina was incised in the midline from the vaginal cup, to 3 cm cephalad of the hymenal ring.  The vaginal mucosa was dissected off of the underlying fibromuscular layer.  Excess vaginal mucosa was trimmed off. The underlying fibromuscular layer was plicated with a series of imbricating stitches, starting with 0-pds suture.  Next, the vaginal mucosa was re-approximated in a running-locked stitch of of 0-Vicryl. At this point, the suspension sutures were passed through the anterior portion of vaginal cuff.  The PDS suture was placed beneath the vaginal epithelium, in the fibromuscular layer. Next the suspension sutures were secured, suspending the vaginal apex to the sacrospinous ligament.  Care was taken to remove the extra slack in the suture, without placing the suture on too much tension. Excellent hemostasis was noted.


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## natashalage (Aug 25, 2020)

Christine, Thank you very much. I was waiting for your help. Thank you.


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## Cmama12 (Aug 26, 2020)

Hi there, just a note that this part -  " A Capio suture device was used to place 2 stitches of 0-PDS, through the sacrospinous ligament, 2 cm medial to the ischial spine, avoiding the pudendal neurovascular bundle. " is part of the work for the suspension, not the anterior/posterior repair.

These can be tricky depending on how well they document but I am only seeing the anterior repair not the posterior repair in this note.   There should be mention of the rectovaginal fascia or at least the rectocele.


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## natashalage (Aug 26, 2020)

Thank you very much, Meg! It's so nice to receive help from the experts. I am all ears.


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