Korbc
Guru
Hello,
I'm pretty sure in the following instance I cannot code 56810 with 57240. Cms does allow a modifier to bypass the edit but I don't think this qualifies to be able to do so but was just wondering anyone's second opinion. Thank you!
The patient presented for scheduled surgery. She had previously been consented. She was taken to the operating room where general anesthesia was found to be adequate. She was prepped and draped in the usual sterile fashion in dorsal lithotomy position. Her bladder was drained. Allis clamps were used on the anterior vaginal mucosa to walk from the bladder neck toward the apex of the vagina, and the lateral aspects of the cystocele were identified and grasped using Allis clamps. The tissue was then undermined using 0.5% Marcaine plain. A knife was used to create an incision from the bladder neck down to the apex of the vagina. Allis clamps were used on the lateral aspects of the vaginal mucosa, and Metzenbaum scissors were used to dissect the mucosa away from the underlying bladder tissue. Using sharp and blunt dissection, this was dissected, and once that was accomplished, 2-0 Vicryl was used in an interrupted fashion to reapproximate the underlying muscular tissue underneath the bladder with improving support. The prolapse was reduced with these steps, and then the vaginal mucosa was slightly trimmed and reapproximated using 3-0 Vicryl. The attention was then turned to the posterior compartment. The Allis clamps were used to grasp the lateral aspects of the hymenal ring and the vaginal mucosa just distal into the vagina, and 0.5% Marcaine plain was used in this area to undermine the tissue. A knife was used to create a diamond incision for the perineoplasty. The skin was dissected off using Metzenbaum scissors. Some dissection was used in the lateral aspects at the level of the hymenal ring in order to create some space to reapproximate the deeper tissue. Once that was accomplished, 2-0 Vicryl was used to reapproximate the underlying tissue to reinforce the space over the rectum. Once that was accomplished, the vaginal mucosa was then reapproximated in the usual fashion using 3-0 Vicryl. Rectal exam was performed. No sutures were noted in the rectum. Rectum was intact. At that point, all the sites were hemostatic. I placed Premarin cream onto the suture lines, and instruments were removed. Sites were hemostatic. The patient tolerated the procedure well. She was taken to the recovery room in good condition.
I'm pretty sure in the following instance I cannot code 56810 with 57240. Cms does allow a modifier to bypass the edit but I don't think this qualifies to be able to do so but was just wondering anyone's second opinion. Thank you!
The patient presented for scheduled surgery. She had previously been consented. She was taken to the operating room where general anesthesia was found to be adequate. She was prepped and draped in the usual sterile fashion in dorsal lithotomy position. Her bladder was drained. Allis clamps were used on the anterior vaginal mucosa to walk from the bladder neck toward the apex of the vagina, and the lateral aspects of the cystocele were identified and grasped using Allis clamps. The tissue was then undermined using 0.5% Marcaine plain. A knife was used to create an incision from the bladder neck down to the apex of the vagina. Allis clamps were used on the lateral aspects of the vaginal mucosa, and Metzenbaum scissors were used to dissect the mucosa away from the underlying bladder tissue. Using sharp and blunt dissection, this was dissected, and once that was accomplished, 2-0 Vicryl was used in an interrupted fashion to reapproximate the underlying muscular tissue underneath the bladder with improving support. The prolapse was reduced with these steps, and then the vaginal mucosa was slightly trimmed and reapproximated using 3-0 Vicryl. The attention was then turned to the posterior compartment. The Allis clamps were used to grasp the lateral aspects of the hymenal ring and the vaginal mucosa just distal into the vagina, and 0.5% Marcaine plain was used in this area to undermine the tissue. A knife was used to create a diamond incision for the perineoplasty. The skin was dissected off using Metzenbaum scissors. Some dissection was used in the lateral aspects at the level of the hymenal ring in order to create some space to reapproximate the deeper tissue. Once that was accomplished, 2-0 Vicryl was used to reapproximate the underlying tissue to reinforce the space over the rectum. Once that was accomplished, the vaginal mucosa was then reapproximated in the usual fashion using 3-0 Vicryl. Rectal exam was performed. No sutures were noted in the rectum. Rectum was intact. At that point, all the sites were hemostatic. I placed Premarin cream onto the suture lines, and instruments were removed. Sites were hemostatic. The patient tolerated the procedure well. She was taken to the recovery room in good condition.
