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Revision Sacrocolpopexy

Cindy Posted Fri 13th of December, 2019 14:40:29 PM
Hello. Uro/Gyn performed surgery on patient with Pre-op Diagnoses: Endometriosis, Perineal Descent, Mesh Complications, Rectocele, pelvic pain. The procedures performed were: Robotic Ovarian Biopsy & Bilateral Salpingectomy, Robotic Revision Sacrocolpopexy; Repair Vaginal Posterior. How should we code the Sacrocolopexy Revision? If you need more details about the surgery, I will provide them. Thank you, Janet
SuperCoder Answered Mon 16th of December, 2019 05:47:30 AM

Thank you for your Question.

Above provided documentation is very limited as revision of Sacrocolpopexy was performed along with major procedures Salpingectomy and vaginal posterior repair. Kindly provide brief procedure detail so that we can provide more appropriate codes. 

Hope that Helps!

 

Cindy Posted Mon 16th of December, 2019 14:36:08 PM
Gladly! "The padded malleable was then elevated and the bladder flap was opened over the top of the anterior mesh. The portion of the mesh between the promontory and the vagina was transected sharply and removed. The portion of mesh along the posterior aspect of the vagina was placed on stretch and dissected off of the vagina with sharp dissection using coag current. Once the mesh was removed the peritoneum was freed up in order to open the pararectal spaces down to the levators. The peritoneum was densely adherent to the outer aspect of the rectum and this was freed up sharply. A 30V LOC 90 suture was used to reinforce the rectum in this area as the dissection was close to the surface of the bowel wall. A new piece of Restoril mesh was cut into a trapezoid approximately 4 x 10 cm and sutured to the puborectalis with interrupted 2-0 PDS sutures. A 30V LOC 180 suture was then used to attach the mesh to the posterior vaginal wall. A piece of mesh cut into a T with a tail to go up to the sacral was then sutured to the anterior mesh as well as the posterior mesh on either side with an interrupted 0 Ethibond. The tail was then sutured to the remnant of the original mesh that had not been removed from the promontory itself using 2 separate interrupted 0 Ethibond sutures. Tisseel fibrin glue was sprayed over the mesh in the rectovaginal septum. The peritoneum was closed over the top of the mesh with running 2-0 V-Loc suture. Both ovaries were well supported distally." (Following completion of the intrabdominal portion of the procedure, is the posterior repair). "The posterior repair was begun. The posterior fourchette was infiltrated with quarter percent Marcaine with epi a total of 10 mL. A midline incision was made in the distal vagina, and the vagina was dissected off of the rectovaginal septum out laterally to the pelvic sidewalls and apically to the robotic dissection. The mesh was grasped with an Allis, a series of 2-0 PDS sutures were placed into the pelvic sidewalls to repair the distal rectocele. The most cephalad 2 sutures incorporated the mesh as well. Once the perineal body was rebuilt, the vagina was closed with 3-0 Vicryl. Most of this procedure was performed with the surgeon's left index finger in the rectum."
SuperCoder Answered Tue 17th of December, 2019 06:25:08 AM

Thank you for providing more detailed procedure note.

 

CPT code 57426 {Revision (including removal) of prosthetic vaginal graft, laparoscopic approach} seems appropriate for the above stated procedure. Kindly check for NCCI edit with other billable CPT codes before billing as per the documentation.

 

 

 

Note: When the provider performs robotic surgery, the provider can only report the code that describes the laparoscopic approach. This is because the robot is a surgical tool, not a separate surgical procedure. The code S2900, Surgical techniques requiring use of robotic surgical system, may be reported for informational purposes to let the payer know the procedure was done with a robot, but there is no additional reimbursement for this code.

 

Hope that helps!

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