Ob-Gyn Coding Alert

Keep modifier 78 handy — you may need it.

To select the appropriate code for vaginal cuff repair, you should ask yourself one question: Why did the ob-gyn need to perform the repair?

Probably one of the most frequently asked questions in an ob-gyn office is, “Which CPT® code should I use for repair of the vaginal cuff?” Unfortunately this is also one of the toughest questions to answer. Consequently everyone seems to have a different opinion about which code to choose. But our coding experts point you in the right direction.

Circumstances Make the Difference

The first thing you should do when the ob-gyn performs a vaginal cuff repair is examine the operative report to determine why the repair was needed. For example, was it part of a staged procedure related to a previous surgery, or caused by loosening sutures or injury or some other reason?

If you have to return to the operating room for a vaginal cuff repair because the original sutures became loose you might think you can report 12020 (Treatment of superficial wound dehiscence; simple closure). But this code is reported for skin wounds that have separated, not wounds inside the vagina. Another possible match might be 57200 (Colporrhaphy, suture of injury of vagina [nonobstetrical]), but the wound dehiscence is not an injury. Your only choice in this case would be to report the unlisted code 58999 (Unlisted procedure female genital system [nonobstetrical]) and compare the work to 57200. Be sure to append modifier 78 (Unplanned return to the operating/procedure room by the same physician or other qualified health care professional following initial procedure for a related procedure during the postoperative period) if the surgeon performs the repair during the global period for the previous surgery.

Example: Approximately a week after undergoing a total abdominal hysterectomy (58150 Total abdominal hysterectomy [corpus and cervix] with or without removal of tube[s] with or without removal of ovary[s]) the patient notices vaginal bleeding. The ob-gyn takes her back to the operating room and must repair the vaginal cuff because of ruptured sutures. In this case you would report 58999-78.

Exception: On the other hand if the surgeon performs the repair because of an injury you would use 57200 (Colporrhaphy suture of injury of vagina [nonobstetrical]). Let’s say a patient slips and catches herself in the shower a week after a total abdominal hysterectomy (58150,  Total abdominal hysterectomy [corpus and cervix] with or without removal of tube[s] with or without removal of ovary[s]) and ruptures the sutures at the vaginal cuff. The ob-gyn returns her to the operating room to repair the cuff. In this case, you would report 57200-78.