# Does anyone know a code for this?



## ksamples (May 13, 2009)

I need a code for closure of the bladder neck transvaginally. 

This is unfortunately all that I have to go on. 

Any suggestions?


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## lring (May 13, 2009)

*clousre*

well the question would have to be - why was it open? - trauma or surgical - if it's surgical it might be included in the global of the procedure

you're going to have to get a little more info I'm afraid - I'm sorry I know this can be hard


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## dmaec (May 13, 2009)

Well, I KNOW this isn't much help - but, my suggestion is:
get more info to go on....... :/
you can't really code anything based on "closure of the bladder neck transvaginally".
I'm not sure why "it's all you have to go on"...don't you have access to the chart note/dictation?... or even the doctor/provider for clarification? Don't you have access as to "why" this procedure (whatever it was) was performed? what the symptoms were, where it was done, (office, OR, etc).. 

sorry, not much help i know...


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## ksamples (May 13, 2009)

*Help! Coding this Operative Report.*

I knew you were going to say that. LOL. Hey here is the actual Operative Report.

Diagnosis: Urinary Incontinence and Neurogenic Bladder

Procedure Performed: Closure of bladder neck, Martius Flap, and Suprapubic Tube Change. 

Findings: The patient had normal appearing urethra. Suprapubic tube was in place. A 40 year-old white female with neurogenic bladder who has had suprapubic tube placed and 2 urethral slings placed in an attempt to occlude her urethra. She continues to have bothersome and near constant incontinence. After discussing optional therapy she elected to undergo bladder neck closure. We have elected to attempt to do this transvaginally. 

Description of Procedure: End of the suprapubic tube was cut off prior to the prep and drape, and just a small portion was left sticking out from the abdomen. Four stay stitches were placed in the urethra. Circumferential incision using cautery was done. Then the cautery and blunt and sharp dissection, I was able to dissect circumferentially the urethra back toward the bladder neck. Once this was completed 3-0 Vicryl was then used to imbricate the end of the urethra. Prior to doing this the absolute end of the urethra was divided to ensure fresh cut edges. Once the urethra was oversewn with multiple imbricating stitches, I then removed the suprapubic tube and placed an 18-French suprapubic tube. I filled the bladder with 120 mL and no leak was noted. At this point I began closing the percervical fascia over the closed urethra. As I got down toward the neck of the bladder, however, this had become quite tense and I was satisfactorily able to pull the tissue over the very ventral proximal aspect. At that time I elected to proceed with Martius flap. An incision was made in the right labia. Labial fat pad was then dissected out leaving it on its blood supply. Subsequently, closed 4-0 chromic. This was brought through the wound, the vaginal incision and laid over the top of the urethra. This is tacked in place with Vicryl as well. I then took Tutoplast and placed some of this over the imbricated urethra and Martius Flap. This then provided what I felt was satisfactory coverage over the urethra. Vagional incision was then closed in interrupted fashion using 3-0 Vicryl.

Just need a code for the closure of the bladder neck transvaginally.


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## jaud63 (May 13, 2009)

*Bladder Neck Repair*

This sounds like CPT 51845. Is it possible to send your provider the description from the Coders Desk Reference with a copy of the CPT code page and specifically ask him? If not, this is what I would go with.


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## ksamples (May 15, 2009)

Will the 51845 work because he didn't do a suspension nor was it Abdomino-vaginal? It was a transvaginal closure.

Suggestions???


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