Yes by the terminology you may be right in assigning the code so - previuos surgery to perineum/ vulva , even to anal sphincter.
But actually, the previous surgery was not alone a perineorraphy; it involved a surgery like a pelvic floor repair, even more so in the sense it involved rectum and anus.
654.73: Why I place it on to .7 because the previous repair (surgery) involved not only perineum but also the whole depth of vagina, rectal mucosa and the anal sphincter during the 4th degree tear.
The basic idea of the Physician contemplating for Elective Cesarean , was this situation is to be considered and treated like a previous surgery of Pelvic Floor Repair/ surgery on the vagina and the rectum(even more than that becuase of the ragged irregular edges of the tear), in which we do not contemplate leaving her for vaginal delivery .
Why the concern is because the whole of the pelvic floor muscles and rectum and the anus sphincter are at risk of tearing again, and, if you leave for vaginal delivery, the effect will be mostly devastating , not just the perineum alone. Hence I would place the code assignment to this 654.7x / 73.
May be you would have been paid with the code you said already. I do not blame that. But what I suggested, would be the CORRECT code by all means.
