desireewhite185@yahoo.com
Networker
- Messages
- 75
- Location
- Newport, VT
Hello,
We have a patient who underwent Vaginal hysterectomy 58260, Anterior/posterior repair 57260 with vaginal colpopexy 57283. Looks like 57283 is bundled with 58260, but our doctors feel it is separate work and should be billable. According to this report do you feel I should be able to bill each of these CPT? The main diagnosis is complete uterine prolapse, N81.3. A&P for N81.6 and N81.11 but I can't use that due to the N81.3. How would you bill this to Medicare VT? Thank you.
Technique-
Patient was brought to the OR with IV fluids running. She was placed supine in dorsal lithotomy position and general anesthesia was administered without any difficulty. Patient was prepped and draped in usual sterile fashion. A Foley catheter was inserted. The uterus was
prolapsing completely through the vaginal introitus. The cervix was grasped with Jacobs tenaculum and infiltrated with dilute solution of lidocaine with vasopressin. A circumferential incision was made on the cervix and vaginal mucosa was then dissected off of cervix using sharp
and blunt dissection. Posterior colpotomy was made entering into posterior cul de sac and a long gooseneck weighted speculum was placed into pelvic cavity.
Uterosacral ligaments were identified bilaterally and grasped with Allis clamps on distal and proximal portion and 0-PDS suture was placed through these points bilaterally and held on clamp for vaginal vault suspension at the end of the procedure. The left uterosacral ligament was
then clamped cut and suture-ligated with hemostasis noted. Next the right uterosacral ligament was clamped, cut and suture-ligated with hemostasis assured. Following this, several further bites were taken along the cervix obtaining cardinal ligaments which were also clamped, cut
and suture ligated bilaterally with hemostasis noted. Next, vesicouterine peritoneal reflection was identified and incised with Metzenbaum scissors entering into anterior cul-de-sac. Next the area of uterine arteries were bilaterally clamped, cut and suture ligated with hemostasis
assured. Next the right and left utero-ovarian ligaments were clamped cut and suture-ligated with hemostasis assured. Uterus was then removed from pelvic cavit. All pedicles were noted to be hemostatic.
Attention was then directed to repair of cystocele. The anterior vaginal wall was grasped with Allis clamps infiltrated with dilute solution of lidocaine and vasopressin. A vertical midline incision was made and carried to 2 cm from the ureteral orifice. The vaginal mucosa was then
dissected off of the underlying bladder. After adequate dissection the bladder was pushed in cephalad direction and the vesicovaginal fascia was then reapproximated using interrupted sutures using 2-0 Vicryl. Redundant vaginal mucosa was then excised and the vaginal mucosa
was then reapproximated using 2-0 Vicryl suture in a running locking fashion with hemostasis assured.
Next the PDS sutures which were held for suspension of vaginal cuff were placed through the anterior and posterior vaginal cuff. Vaginal cuff was then closed with 0 Vicryl suture in running locking fashion with hemostasis assured. Uterosacral vaginal vault suspension sutures were
then tied. Foley catheter was removed and cystoscopy was performed with ureteral jets noted bilaterally and normal bladder mucosa indicating no injury to bladder from procedure.
Attention was then directed to repair of rectocele. Posterior vaginal mucocutaneous junction was grasped with Allis clamps and an Allis clamp was also placed in the midline on posterior vaginal wall and a diamond-shaped area extending from clamp on posterior vaginal wall to 2
Allis clamps on mucocutaneous areas of the vagina to perineal body was incised and the vaginal mucosa and skin overlying this area was removed. Vaginal mucosa was then reapproximated with 2-0 Vicryl suture along with the reapproximation of rectovaginal fascia. Vaginal
mucosa was closed to level of perineum and the remainder of perineal skin defect was closed with 3 interrupted 2-0 Vicryl suture with hemostasis noted. Rectal digital exam was done and no suture material was noted in rectum.
We have a patient who underwent Vaginal hysterectomy 58260, Anterior/posterior repair 57260 with vaginal colpopexy 57283. Looks like 57283 is bundled with 58260, but our doctors feel it is separate work and should be billable. According to this report do you feel I should be able to bill each of these CPT? The main diagnosis is complete uterine prolapse, N81.3. A&P for N81.6 and N81.11 but I can't use that due to the N81.3. How would you bill this to Medicare VT? Thank you.
Technique-
Patient was brought to the OR with IV fluids running. She was placed supine in dorsal lithotomy position and general anesthesia was administered without any difficulty. Patient was prepped and draped in usual sterile fashion. A Foley catheter was inserted. The uterus was
prolapsing completely through the vaginal introitus. The cervix was grasped with Jacobs tenaculum and infiltrated with dilute solution of lidocaine with vasopressin. A circumferential incision was made on the cervix and vaginal mucosa was then dissected off of cervix using sharp
and blunt dissection. Posterior colpotomy was made entering into posterior cul de sac and a long gooseneck weighted speculum was placed into pelvic cavity.
Uterosacral ligaments were identified bilaterally and grasped with Allis clamps on distal and proximal portion and 0-PDS suture was placed through these points bilaterally and held on clamp for vaginal vault suspension at the end of the procedure. The left uterosacral ligament was
then clamped cut and suture-ligated with hemostasis noted. Next the right uterosacral ligament was clamped, cut and suture-ligated with hemostasis assured. Following this, several further bites were taken along the cervix obtaining cardinal ligaments which were also clamped, cut
and suture ligated bilaterally with hemostasis noted. Next, vesicouterine peritoneal reflection was identified and incised with Metzenbaum scissors entering into anterior cul-de-sac. Next the area of uterine arteries were bilaterally clamped, cut and suture ligated with hemostasis
assured. Next the right and left utero-ovarian ligaments were clamped cut and suture-ligated with hemostasis assured. Uterus was then removed from pelvic cavit. All pedicles were noted to be hemostatic.
Attention was then directed to repair of cystocele. The anterior vaginal wall was grasped with Allis clamps infiltrated with dilute solution of lidocaine and vasopressin. A vertical midline incision was made and carried to 2 cm from the ureteral orifice. The vaginal mucosa was then
dissected off of the underlying bladder. After adequate dissection the bladder was pushed in cephalad direction and the vesicovaginal fascia was then reapproximated using interrupted sutures using 2-0 Vicryl. Redundant vaginal mucosa was then excised and the vaginal mucosa
was then reapproximated using 2-0 Vicryl suture in a running locking fashion with hemostasis assured.
Next the PDS sutures which were held for suspension of vaginal cuff were placed through the anterior and posterior vaginal cuff. Vaginal cuff was then closed with 0 Vicryl suture in running locking fashion with hemostasis assured. Uterosacral vaginal vault suspension sutures were
then tied. Foley catheter was removed and cystoscopy was performed with ureteral jets noted bilaterally and normal bladder mucosa indicating no injury to bladder from procedure.
Attention was then directed to repair of rectocele. Posterior vaginal mucocutaneous junction was grasped with Allis clamps and an Allis clamp was also placed in the midline on posterior vaginal wall and a diamond-shaped area extending from clamp on posterior vaginal wall to 2
Allis clamps on mucocutaneous areas of the vagina to perineal body was incised and the vaginal mucosa and skin overlying this area was removed. Vaginal mucosa was then reapproximated with 2-0 Vicryl suture along with the reapproximation of rectovaginal fascia. Vaginal
mucosa was closed to level of perineum and the remainder of perineal skin defect was closed with 3 interrupted 2-0 Vicryl suture with hemostasis noted. Rectal digital exam was done and no suture material was noted in rectum.