# Laparoscopic Hysterectomy with TVT sling



## MARYWALSH88 (Dec 22, 2017)

Hi Thank you in advance for your reviews:
Physician is performing Laparoscopic Hysterectomy
After performing Laparoscopic Hysterectomy all instruments were removed, and gas expressed, he then developed the periurethral tunnels, and right at mid urethra.  She had a previously placed tranobturator sling which was not angled enough, so he  decided to do a retropubic sling, he made 2 stab incisions right/left of pubic symphysis and with little finger placed the trocar through each of these incisions and it came out the periurethral tunnel, then he grabbed the sling and pulled it through. He removed the plastic tab and closed the vagina.

My question is do you consider the a 51992 Laparoscopic or 57288 open?


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## csperoni (Dec 22, 2017)

My vote is option 3 - 57287 removal or REVISION of sling for stress incontinence.    Per SuperCoder, the procedure is done vaginally (with small incisions if necessary) or abdominally.  It reads to me that this procedure was done vaginally with stab incisions to help guide the placement of existing sling.  If he in fact placed an entire new sling, then 57288 (which is for vaginal or abdominal).


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## hagand (Feb 12, 2018)

*Is it 57288 or 51992???*

So we coders have an issue where we are in disagreement with the office on how this should be coded.  Please see below.  I see trocars, I'm thinking its laparoscopic.  If it is not, can someone please direct me to concrete evidence that this should be coded as 57288?  Thank you in advance.  

Pre-op Diagnosis: 
Incontinence of urine with stress incontinence only.  After thorough discussion of all treatment options, risks and benefits she elects to proceed with minimally invasive mid urethral sling surgery. She gives informed consent.

Procedure(s):
TRANSVAGINAL TAPING/Cystoscopy (N/A) Procedure(s):
 TRANS VAGINAL TAPING / TRANSOBTURATOR placement. (N/A) with ARIS Tape:  This patient was brought to the operative and placed under adequate LMA with venodyne boots in place and preoperative IV antibiotics given. She was placed in dorsal lithotomy position. Sterile Betadine prep and drape was done. Final timeout was completed. 
*
A 21 French cystoscope was introduced under direct vision per urethra. Panendoscopic examination bladder was normal. Ureters were normal in position and shape. The patient had an 18 French Foley catheter placed to closed drainage and the bladder was empty. 
*
10 mL of 1/4% Marcaine with epinephrine were injected overlying the ischiopubic arch in both left and right side in the genitofemoral skin crease. A 1 cm incision was made in the skin crease on both left and right sides at this level. I now placed 10 mL of the Marcaine and epinephrine overlying the region of the mid urethra and the vaginal skin. A 2 cm incision was made overlying the mid urethra vertically and then lateral dissection was done so I could palpate the posterior surface of the ischiopubic  Arch. A curved trocar was now passed around the left ischiopubic arch and brought out through the vaginal incision with no unwanted perforation. One end of the ARIS tape was brought out through the trocar. I now passed a second trocar in the other side and carefully brought out one end of the tape with no unwanted perforations noted on exam. The tape was position underlying the mid urethra with no additional tension. The edges of the tape were trimmed at the genitofemoral skin level and then the vaginal incision was closed with a running locking 2-0 Vicryl stitch. A vaginal packing with antibody solution was placed. The genitofemoral skin incisions were closed with interrupted 4-0 Monocryl buried suture. The patient was awoken and brought to the operating room in good condition.


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