Wiki Post-op vaginal cuff dehiscence repair

[debpauldo]

Hello,

I am in need of a CPT Code for vaginal cuff repair, the patient had a TAH/LOA, presented to the ER with pain and watery discharge after having sexual intercourse. Diagnostic Laparoscopy was used to probe the area.

The vaginal cuff was sutured in interrupted fasion. I hope this is enough info.


Thank you,

 

[csperoni]

There's no exact code, but you do have a few options.
From https://www.mdedge.com/obgyn/article/61388/practice-management/emergency-repair-vaginal-cuff
There is no CPT code specific to the repair of the vaginal cuff. The closest codes seem to be:

• 57200 (colporrhaphy, suture of injury to vagina [nonobstetrical]),
• the complex repair codes 13131-13133 (repair, complex, forehead, cheeks, chin, mouth, neck, axillae, genitalia, hands, and/or feet),
• 13160 (secondary closure of surgical wound or dehiscence, extensive or complicated), or
• the unlisted code 58999.

I do have a question regarding "diagnostic laparoscopy was used to probe the area." I've seen this a handful of times, but in my experience, injury was always examined and repaired vaginally. 57423 could be a consideration if the examination and repair was done laparoscopically.
Without that sentence, I would use 57200 since it was specifically an injury after intercourse, not just loose sutures.
Don't forget your modifier if you were the surgeon doing the TAH and in the global.