areeder
Networker
Hello,
Could someone help me understand the difference in coding a 57250 vs 45560?
...two Allis clamps were utilized to grasp the hymeneal tags and the posterior wall of the vagina then injected with 0.25% Marcaine with epinephrine. A triangular portion of the posterior fourchette was excised with a knife and then an incision was make in the midline on the posterior wall of the vagina and taken up to the apex of the vaginal vault with Metzenbaum scissors. The vaginal mucosa was retracted with Allis-Adair clamps and the rectocele then sharply dissected off of the vaginal mucosa. Rectal exam was performed and no obvious enterocele was noted, although the tissue was very redundant at the apex and therefore a #2.0 Vicryl suture was utilized in a purse-string fashion to plicate together this large upper defect in case there was an occult enterocele. During the dissection, it was noted that the patient had a site specific defect with the perirectal facia being predominantly in the lower part of the posterior space. The upper area was then plicate with interrupted #0 Vicryl sutures to bring the perirectal fascia then closer together and then a site specific repair was utilized after mobilizing the perirectal fascia from below. This was then attached with interrupted #0 Vicryl sutures to the apex of the dissection where some perirectal fascia did exist. Redundant tissue was then trimmed and the tissue brought together in the midline with a #2-0 Vicryl suture in a running interlocking fashion. The perineal body was then built up with 2 figure of eight #0 Vicryl stitches and then the remainder of the perineum brought together with deep stitches followed by a subcuticular stitch to bring together the outer tissues...
on this case I am leaning towards 57250 but if I am right, I am still confused as to when we would code 45560.
Any help is appreciated.
Thanks!
Could someone help me understand the difference in coding a 57250 vs 45560?
...two Allis clamps were utilized to grasp the hymeneal tags and the posterior wall of the vagina then injected with 0.25% Marcaine with epinephrine. A triangular portion of the posterior fourchette was excised with a knife and then an incision was make in the midline on the posterior wall of the vagina and taken up to the apex of the vaginal vault with Metzenbaum scissors. The vaginal mucosa was retracted with Allis-Adair clamps and the rectocele then sharply dissected off of the vaginal mucosa. Rectal exam was performed and no obvious enterocele was noted, although the tissue was very redundant at the apex and therefore a #2.0 Vicryl suture was utilized in a purse-string fashion to plicate together this large upper defect in case there was an occult enterocele. During the dissection, it was noted that the patient had a site specific defect with the perirectal facia being predominantly in the lower part of the posterior space. The upper area was then plicate with interrupted #0 Vicryl sutures to bring the perirectal fascia then closer together and then a site specific repair was utilized after mobilizing the perirectal fascia from below. This was then attached with interrupted #0 Vicryl sutures to the apex of the dissection where some perirectal fascia did exist. Redundant tissue was then trimmed and the tissue brought together in the midline with a #2-0 Vicryl suture in a running interlocking fashion. The perineal body was then built up with 2 figure of eight #0 Vicryl stitches and then the remainder of the perineum brought together with deep stitches followed by a subcuticular stitch to bring together the outer tissues...
on this case I am leaning towards 57250 but if I am right, I am still confused as to when we would code 45560.
Any help is appreciated.
Thanks!