# 57265? Only? New to ob coding



## MELJNBBRB (Jan 6, 2015)

Hi list, 
Based on below, would you only code 57265? Still trying to tackle some of the OB/Gyn surgeries.
Any help is greatly appreciated!


PROCEDURE:
Cystocele repair, rectocele repair, enterocele repair, vaginal
cuff suspension and cystoscopy.


ANESTHESIA:
General.


DESCRIPTION OF PROCEDURE:
After induction of satisfactory general anesthesia, the patient
was prepped and draped in usual sterile manner for vaginal
surgery.  The bladder was drained with return of clear urine.
She was noted to have the vaginal apex prolapse to the hymen
along with the transverse portion of the anterior compartment and
the upper portion of the posterior compartment.  The perineal
body was hypermobile. She also was noted to have a midline
rectocele.


Marking sutures were placed at 3 and 9 o'clock.  A vertical
incision was made in the anterior compartment from the proximal
portion of the anterior compartment across the cuff into the
upper portion of the posterior compartment.  The vaginal
epithelium was reflected away from the underlying connective
tissue.  The enterocele sac was entered by sharp dissection.  The
remnants of uterosacral ligament were identified on each side.
The bowel was packed out of the operative field.  The suture 0
Maxon followed by 2 sutures of 2-0 Tycron were placed posterior
and medial to the ischial spines on both sides.  The suspensory
sutures were placed in the transverse portion of the rectovaginal
septum, and pubocervical fascia.  Lap and sponge count were
correct x2.  The suspensory sutures were tied giving excellent
support to the apex of the vagina and correction of the support
defects.  The bladder was drained with return of clear urine.
Cystoscopy was performed using a 70-degree cystoscope and 100 mL
of 50% dextrose.  Urine was noted to come promptly from both
ureteral orifices.  These there was no evidence of injury to the
bladder or urethra.  The bladder was drained.  The suspensory
sutures were trimmed.  The epithelial incision was closed with
continuous Vicryl suture.  There was excellent support for the
apex of the vagina and correction of the apical defects.


A digital rectal exam was performed.  She was noted to have a
midline rectocele and a vertical incision was performed inside
the vaginal canal just inside the genital hiatus.  The vaginal
epithelium was reflected away from the underlying rectovaginal
septum.  The septum was approximated using interrupted 2-0 Vicryl
sutures.  The skin was closed with subcuticular 3-0 Vicryl
suture.
A small tag of tissue at 5 o'clock at the hymen was excised and
the skin incision closed with 3-0 Vicryl.


Lap and sponge counts were correct.  Hemostasis was good.  The
patient received 800 mL of normal saline intravenously.  Blood
loss was approximately 100 mL.  She was given 30 mg of Toradol
intravenously.  A vaginal pack covering with clindamycin was
placed in the vaginal canal.  The catheter was left draining
clear urine.  The patient was returned to the recovery room
stable.


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## Lashel (Jan 6, 2015)

I did a little research and from what I could tell it looked to me like you could code for the vaginal cuff suspension. Code 57282 with a modifier 51. I got that information from the CPT assistant. If you don't have access to it, it is worth the subscription price. I find it really helpful in doing research. Of course, as I always like to note, your third party payers may have different ideas and opinions on bundling. 

from CPT
57282
Sacrospinous ligament fixation for prolapse vagina

Typically performed for the correction of vaginal prolapse following hysterectomy, this procedure may be performed prophylactically for total uterine prolapse and has the advantage of preserving vaginal function. CPT code 57282 is intended to report the procedure where the apex of the posterior vaginal wall is sewn to the sacrospinous ligament between the sacrum and the ischial spine. 
Similarly, during reconstructive pelvic surgery, when either a vaginal or abdominal paravaginal defect repair is performed to correct stress urinary incontinence or cystocele formation, and in addition a separate procedure for correction of vaginal vault inversion such as a sacrospinous ligament fixation (code 57282) or an abdominal colpopexy (code 57280) is performed, then code 57282 or 57280 with modifier -51 may be reported


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## MELJNBBRB (Jan 6, 2015)

Thank you so much for your time and reply! I did find that Cpt assistant article after you mentioned it. Thank you again for taking the time to reply. Much appreciated!
Melissa B. CPC,CCS


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## michelleaapc2012 (Jun 6, 2017)

*Hymenal tag remnants excised, need help please, claim denied*

Hi, I am stumped on a Dx code for the hymen tag. I used CPT 56700 partial hymenectomy and Dx N89.8 other specified noninflammatory disorders of vagina. I used that Dx because ICD-9 623.8 was for hymenal tag and this is the closest crosswalk that I could get that matched what the patient has. Tricare has denied the claim stating the diagnosis code is inconsistent with the procedure. Any suggestions. The patient had two hymenal remnants that were excised. Any suggestions?


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