Ob-Gyn Coding Alert

Question: Two weeks after undergoing a vaginal hysterectomy, a patient presented with heavy vaginal bleeding. The ob-gyn found the bleeder near the vaginal cuff and fixed it. How should we code this? California Subscriber Answer: Although you may be tempted to use 57200 (Colporrhaphy, suture of injury of vagina [nonobstetrical]), the American College of Obstetricians and Gynecologists (ACOG) disagrees. According to ACOG, you should use the unlisted-procedure code (58999, Unlisted procedure, female genital system [nonobstetrical]) because the vaginal cuff bleeding is not due to a vaginal tear or injury, but because of sutures that may come loose or are not tight enough to prevent bleeding from the surgical site. Essentially, the physician is resuturing. When submitting an unlisted-procedure code, be sure to include the operative report to show the payer exactly what services and procedures the ob-gyn performed. The most ideal codes would be the repair codes (12001-12007 or 12041-12047), but these specify external genitalia. The codes for a complex repair (13131-13133) only indicate genitalia (which can mean external and internal), but most of the descriptions for vaginal cuff repair do not seem to be complex repairs. Also, complex repairs require the size of the repair to be documented. The best code of all would be 13160 (Secondary closure of surgical wound or dehiscence, extensive or complicated). But ACOG stated that this code should be used for skin dehiscence, not vaginal cuff dehiscence.