Ob-Gyn Coding Alert

Question: My ob-gyn did a surgical exploration of the abdomen with re-suturing of both the vaginal cuff and ovarian pedicles. He also did a re-peritonealization of the abdominal wall. In a recent Ob-Gyn Coding Alert issue, I learned to use 12020 and 57200 for a repair of vaginal cuff.

According to my ob-gyns op report, however, the ob-gyn used an abdominal approach. He states, I prepped and draped the abdomen. I took out old staples, carefully inspected the incision, and opened the fascia. There was no evidence of bleeding from the muscles. Then I opened the peritoneum and explored the abdominal cavity. There were approximately three units of old clotted blood in the pelvic cavity. This was then evacuated. There appeared to be some oozing from the bladder flap peritoneum. I then decided to re-sew the vaginal cuff, which had staples prior. I placed approximately 6-8 figure-of-eight sutures across the vaginal cuff. I then sutured the peritoneum. Should I still use 12020 and 57200?

California Subscriber

Answer: No. You should report 49002 (Reopening of recent laparotomy) because the ob-gyn was exploring for hemorrhage. This code covers the removal of the clotted blood as well as the re-suturing.

You are right to question using 12020 (Treatment of superficial wound dehiscence; simple closure) and 57200 (Colporrhaphy, suture of injury of vagina [nonobstetrical]). These codes are for either the simple closure of skin at the site of the wound separation or a vaginal approach procedure. In this case, the procedure included a full exploration of the abdominal cavity with suturing performed through that incision.