# Lap Uterosacral ligament Colposuspesnion



## catharine (Dec 10, 2015)

I could use some help on coding a Lap Uterosacral Ligament Colposuspension.
I did extensive research and found that the unspecified code 49329 should be used for this procedure.  However I get  denials from Medicare that there is another appropriate code for this procedure.  The only one that comes close would be 57425, but again, I don't think that code is correct. Im good with the hysterectomy code its only the ULC im having issues with.  Any help would be greatly appreciated. 

OPERATIVE PROCEDURE:

Total laparoscopic hysterectomy, bilateral salpingectomy and uterosacral

ligament colposuspension

ANESTHESIA:

General endotracheal intubation.

 ESTIMATED BLOOD LOSS:

50 mL.

 FINDINGS:

Upon entering the abdomen, the right hemidiaphragm and right and left

dome of the liver were entirely normal.  The visualized portions of the

omentum and small and large bowel were also normal.  There was no

peritoneal studding.  The appendix was retrocecal and was not removed. 

Looking in the pelvis, the fibroid uterus was enlarged to approximately

10 weeks' size and had a pedunculated fundal fibroid that measured 10 x

8 cm.  The bilateral ovaries were normal.  The tubes were normal.  There

was no ascites.  The hysterectomy and salpingectomy were accomplished

without complication.  At the end of the operation, there was perfect

hemostasis and the sponge and instrument counts were correct.



DESCRIPTION OF PROCEDURE:

With the patient prepped and draped in the modified lithotomy position

in the standard sterile fashion after ascertaining adequate general

endotracheal anesthesia, a pause was held to reidentify the patient and

reconfirm the purpose of the surgery.



Attention was then turned to the umbilicus, which was everted and

injected generously with Marcaine and a 5 mm vertical incision was made.

 Skin edges were elevated on towel clips and a trocar was inserted

directly into the abdomen with visual confirmation.  The upper abdomen

was explored and then the patient was placed in steep Trendelenburg. 

The pelvis was examined and then the procedure was begun by incising

along the mesosalpinx on the right side, then through the uteroovarian

ligament and then the right round ligament was cauterized and incised. 

Then the uterus was pushed upward and a bladder flap was created.  The

uterine artery was identified and skeletonized and then cauterized

generously and then incised.  The pubocervical fascia was incised down

to the vaginal epithelium.  Hemostasis was secured and attention was

turned to the right side.

 On the right side, the mesosalpinx was incised all the way over to the

uterus.  The utero-ovarian ligament was cauterized and incised.  Then

the round ligament was cauterized and incised.  The uterus was pushed

upward and then the bladder flap was completed.  The cervical cup was

easily visible.  The uterine artery was cauterized and incised and then

the pubocervical fascia was incised circumferentially into the vagina,

freeing up the uterus and tubes.  Uterus was brought down through the

vagina without difficulty; however, the massive fibroid was then

disconnected from the uterine fundus at the level of the peduncle and it

too was brought out through the vagina without difficulty.  The

bilateral ovaries were reconfirmed to be normal.  There was no

endometriosis.  Suture was passed up through the vagina.  Taking the

uterosacral ligament with suture and incorporating the uterosacral

ligament into the pubocervical fascia with sutures on each side gave

good elevation to the prolapsed vagina.  The vagina itself was reefed

with a V-Loc suture with good hemostasis and then the suture was sutured

back on itself.  There was perfect hemostasis.  The sponge and

instrument counts were correct.  The ovaries were normal.  The gas was

carefully and thoroughly deflated from the abdomen and then the trocars

were removed and the incisions were treated with the vertical inverted

subcuticular suture of 4-0 Monocryl and then treated with Dermabond. 

The patient tolerated the procedure well.  She was awakened, extubated

and taken to recovery room in good condition


----------

