Wiki Episioproctotomy code

[erothacker@yahoo.com]

Is there a CPT code for an episioproctotomy? Doctor did this procedure with RV fistula repair & anal sphincter repair. I'm not familiar with this procedure & can't find CPT code for it.

 

[kathrynw]

Hello,
NCBI describes the use of and definition of an episioproctotomy as the following: "When an anterior sphincter defect coexists in women with an RVF, the surgeon should strongly consider repairing the sphincter defect with the RVF repair. This can be accomplished with either a rectal advancement flap performed in concurrence with an anterior sphincteroplasty or as the case at our institution, an episioproctotomy is performed. An episioproctotomy entails performing a fistulotomy and creating of a defect similar to a fourth degree perineal laceration during vaginal childbirth. A compete debridement of the granulation tissue of the fistula tract is carried out along with lateral identification and mobilization of the sphincter muscles. The rectal mucosa is repaired initially. Then an overlap of the sphincter muscles is accomplished. Finally the vaginal mucosa is approximated which completes the repair. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4231514/

The lay terms and clinical responsibility for code 57308 are as follows: In this procedure, the provider closes the rectovaginal fistula but makes an incision through the perineum. The provider must repair the perineum afterward and may shorten the levator muscle, when necessary, during this procedure.

Clinical Responsibility The provider places the patient in a dorsal lithotomy position and administers anesthesia. The physician starts the surgery by making an upside–down U incision in the perineum and exposes the external anal sphincter. He then places a probe into the fistula to locate the exact tract it is taking. The physician then separates the fistula tract from the anal sphincter and he cuts away any of the vaginal and rectal mucosa that are part of the fistula. He then identifies the tissue under the anal sphincter and repairs it with suture. He then covers the sphincter with rectovaginal fascia and sutures the area closed. The physician then closes the original perineal incision using sutures. If there was any perineal laxity before the surgery, the physician shortens the levator ani muscle by making folds or tucks on its walls and incorporates this muscle into the surgical closure.

Hopefully you can use these definitions and the operative report from your provider to see if 57308 is the correct CPT code in this scenario.

Good Luck,