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 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 (Return to the operating room 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.