Emergency repair of the vaginal cuff
<huc>Q</huc> We have a patient who, 3 weeks after a vaginal hysterectomy, presented to the emergency room with significant vaginal bleeding. She was taken to the operating room for a vaginal-approach exploration and suture of the vaginal cuff. How would I code for this?
<huc>A</huc> This situation seems to occur quite frequently, judging from the number of questions I get on the topic. 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.
Of the 4 choices, I favor the complex repair codes, since they specifically mention repair of the genitalia—which would include both the external and internal structures. The downside is that, in order to use these codes, the size of the repair must be documented and more than just a layered closure must be used. Note that the codes for simple and intermediate repair (12001-12007 and 12041-12047) specify external genitalia, and therefore could not be used in this instance.
In order to select code 13160, the repair would have to be extensive or complicated—and, of course, the documentation would need to support that.
I am not sure how payers will look upon code 57200. You must use diagnosis code 998.31 (disruption of internal operation wound) to indicate the reason for the repair, but some payers may not consider this a match with 57200.
Picking the unlisted code is the least desirable option, unless the physician did something other than repair the vaginal cuff.
No matter which code you choose, remember to add modifier -78 (return to operating room for a related procedure during the postoperative period).