Wiki Excision of granulation tissue with repair of the perineal and posterior defect, similar to a posterior repair.

[TanBro]

Patient was consented and taken to the operating room. After induction of adequate general anesthetic, sterilely prepped and draped in the dorsal lithotomy position. There was pedunculated granulation tissue at the perineum and off to her right. There was granulation tissue along the midline where the previous episiotomy/incision were. Allis clamps were used along the lateral aspects of the normal vaginal mucosa to elevate this and excise the granulation tissue and the underlaying scar. The was sent to Pathology. Cautery was used where necessary for hemostasis in the subcutaneous tissue. Interrupted sutures of 0 vicryl were used to reapproximate the subcutaneous tissue. The vaginal mucosa was closed with interrupted 0 vicryl sutures alond the vaginal mucosa and down to the level of the perineum. Defect closed. Hemostasis present. Estimated blood loss 30 ML.

So, my question is on the perineal and posterior defect repair. Since it was similar to a posterior repair would I use 57260? Or is there a better code I'm not finding? I know the granulation tissue removal is going to be an unlisted 58999 with compared work 57135. Any advice would be appreciated.

 

[TanBro]

Still looking for advice on this if anyone has any.

 

[Cmama12]

Hi Tanya, I don't think is similar to a posterior repair . I'll paste an example of one below. My first thought was 56810 - however, that is meant to be non-ob repairs. If this is an old scar, I still would be inclined to try it. Otherwise, I would likely go with 1142x. If you can get the dimensions of the scar you can code to the correct length; otherwise I would default to 11420. It sounds like the granulation tissue was removed with the scar, so I wouldn't add an additional code.

Here's an example of a posterior repair (with perineorrhaphy)

We placed an Allis clamp approximately 1 cm from the introitus at midline. We then injected bilaterally with 10 mL of 0.25% Marcaine with Epinephrine. We then used a scalpel to create a large rectangle between the 2 lateral stays and the Allis at midline. We then dissected the excess vaginal epithelium. We used Metzenbaum scissors to undermine the vaginal epithelium and dissected away the vaginal epithelium away from the underlying rectovaginal fascia. This was taken up to 1 cm from the apex and laterally as possible. Once this was done, we were able to clearly see the defective rectovaginal fascia. We then used 2-0 PDS and began the first layer of reapproximating the fascia in a series of interrupted sutures and reapproximated the fascia at midline until 1 cm from the introitus. We then used 0 Vicryl to recreate the perineum, going through the transverse perineum on the patient's left side and then to the right side holding onto the hemostat going 1 cm more lateral and anterior through the bulbocavernosus and final then 2 more sutures lateral than this. We then trimmed the excess vaginal epithelium. We then closed the incision with a 2-0 Vicryl in a running fashion, taking care with every other suture to incorporate some of the previously plicated fascia at midline. This was taken down all the way through the perineal repair. Everything was noted to be hemostatic. Foley catheter was placed. The Foley catheter remained in situ. NO Vaginal packing was placed. Patient taken out of dorsal lithotomy, taken out of general anesthesia and to recovery room in stable condition.

 

[TanBro]

Hi Tanya, I don't think is similar to a posterior repair . I'll paste an example of one below. My first thought was 56810 - however, that is meant to be non-ob repairs. If this is an old scar, I still would be inclined to try it. Otherwise, I would likely go with 1142x. If you can get the dimensions of the scar you can code to the correct length; otherwise I would default to 11420. It sounds like the granulation tissue was removed with the scar, so I wouldn't add an additional code.

Here's an example of a posterior repair (with perineorrhaphy)

We placed an Allis clamp approximately 1 cm from the introitus at midline. We then injected bilaterally with 10 mL of 0.25% Marcaine with Epinephrine. We then used a scalpel to create a large rectangle between the 2 lateral stays and the Allis at midline. We then dissected the excess vaginal epithelium. We used Metzenbaum scissors to undermine the vaginal epithelium and dissected away the vaginal epithelium away from the underlying rectovaginal fascia. This was taken up to 1 cm from the apex and laterally as possible. Once this was done, we were able to clearly see the defective rectovaginal fascia. We then used 2-0 PDS and began the first layer of reapproximating the fascia in a series of interrupted sutures and reapproximated the fascia at midline until 1 cm from the introitus. We then used 0 Vicryl to recreate the perineum, going through the transverse perineum on the patient's left side and then to the right side holding onto the hemostat going 1 cm more lateral and anterior through the bulbocavernosus and final then 2 more sutures lateral than this. We then trimmed the excess vaginal epithelium. We then closed the incision with a 2-0 Vicryl in a running fashion, taking care with every other suture to incorporate some of the previously plicated fascia at midline. This was taken down all the way through the perineal repair. Everything was noted to be hemostatic. Foley catheter was placed. The Foley catheter remained in situ. NO Vaginal packing was placed. Patient taken out of dorsal lithotomy, taken out of general anesthesia and to recovery room in stable condition.

Thankyou!!