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Tag Archives: vaginal

Vaginal Fistula Repair

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Good Morning –
I’m fairly new to Urology and I have an op report that has me a little confused.
The primary procedure is 57295 Revision of Vaginal Graft. However he also repaired/closed 3 vaginal mucosal fistulous tracts and that is where I’m getting hung up.
When asked if these might be considered rectovaginal, urethrovaginal, vesicovaginal the doctor replied "none of the above". I can’t seem to locate anything else that might qualify.

Are the fistula repairs included in the revision? or Do I just need to add a 22 to the 57295 and move on? :-)
Any suggestions greatly appreciated – thank you!

The fistulous tract from where the mesh was protruding was evaluated. The edges of this fistula were freshened with Metzenbaum scissors. The fresh mucosal edges were then sutured together primarily with 2-0 Vicryl suture. Good closure of the fistulous tract was identified. The two midline fistulous from where the mesh previously extruded were identified. These fistulous tracts were mucosalized. The mucosa of the fistulous tract was removed and the new mucosal raw edges were sutured together using running 2-0 Vicryl sutures. This was performed for each of the identified midline fistulous tracts. Good coaptation of the vaginal mucosa was achieved. A good closure of the fistula tracts were identified.

Medical Billing and Coding Forum

icd-10-cm code for vaginal cuff dehiscence post hysterectomy

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What’s the best diagnosis for a vaginal cuff rupture/dehiscence? This is about 3 months after hysterectomy, op report says "vaginal cuff open approximately 1 inch with bowel present at the cuff edge.". I keep finding N99.3-vaginal vault prolapse after hysterectomy– but that doesn’t sound right to me.

Medical Billing and Coding Forum

s/p revision of vaginal septum resection secondary to postoperative hemorrhage

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I am trying to code for s/p revision of vaginal septum resection secondary to postoperative hemorrhage but I am at a loss. Has anyone else coded for this before? Thanks in advance 😮

Operation – Exam under anesthesia, Repair Vaginal Tear, revison of vaginal septum resection ,control of post op hemorrhage

The patient was taken to the OR where general endotracheal anesthesia was induced. The patient was placed in the dorsal lithotomy position with her legs supported using candy cane stirrups. The patient was then prepped and draped in the normal sterile fashion. A time-out was performed to confirm correct patient, correct procedure. A deaver retractor was used to visualized the vagina. A large clot was evacuated. The vagina was then copiously irrigated with sterile water. The vagina was then inspected and a largely intact incision was noted longitudinally, both inferior and superior. Two cervices were noted and appeared normal. An small area of separation was noted, with a small amount of active bleeding. The posterior portion of the incision was oversewn from the apex to the introitus using 3-0 vicryl in a running/locked fashion. One small area about 1 cm above the introitus in this incision line continued a bleed. A figure of 8 was placed using the same suture. Excellent hemostasis was noted. The vagina was then packed the Kerlix with premarin cream. A foley catheter was placed without difficulty. All sponge, lap, and needle counts were correct x 2 at the end of the procedure. The patient tolerated the procedure well and was transferred to the recovery room in stable condition.

Medical Billing and Coding Forum

Non-menopause related vaginal dryness ICD DIAG code?

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What is the most specific ICD 10 code for a non-menopausal women experiencing vaginal dryness? From the ICD 10 Index under atrophy/vagina (senile) I see N95.2 which takes you to the menopause/peri-menopausal section. Patient is in her early 30’s. No documentation of low estrogen.

Thanks for the help!

Medical Billing and Coding Forum

Vaginal Flap code?

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I am needing some help with a CPT code. The doctor performed a partial vulvectomy 56620 and then did a vaginal flap advancement 15574. A co-worker and I are not agreeing with this code. The dictation reads:

Using a #15C scalpel, I excised a butterfly-shaped piece of tissue, which was essentially the entire vulvar vestibule. This included some of the vagina from the vaginal introitus and part of the perineal body. I marked the specimen at 6oclock at the vaginal opening, as well as the right edge with two different colored sutures. Complete full-thickness skin excision was performed. I then obtained homeostasis with the Bovie electrocoagulator. A vaginal flap was going to be needed to close off this area. I then undermined the posterior vaginal wall with a Metzenbaum scissors and I advanced and dissected away the posterior vaginal wall from the underlying Denonvillers fascia and the rectovaginal space until i could easily mobilize full-thickness distal posterior vagina and stretch it to the perineal skin to be able to close this area of excision. Multiple layers were closed to close off any dead space. Approximately a 5-layer closure was performed to close off any dead space between the posterior vaginal wall and the Denonvilliers fascia. This also took the tension off the vaginal skin and perineal skin. Once the vagina was completely mobilized and the dead space was closed, I was able to re-approximate the vaginal mucosa on the introitus to the skin of the perineum. The corners of the ellipse toward the labia minora were closed with interrupted 3-0 vicryl on the cutting needle. The rest of the vaginal incision was closed in a subcuticular fashion.

Any help would be much appreciated!

Thank you
Jenny G

Medical Billing and Coding Forum

Correct Coding for Laparoscopically Assisted Vaginal Hysterectomy

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Be sure you know the difference between the various types of laparoscopic hysterectomies. In the article “Pinpoint Correct Hysterectomy Coding” (August 2018, pages 16-18), the statement, “… a laparoscopic-assisted vaginal approach — a ‘subset’ of the vaginal approach — in which a scope is inserted via small incisions in the vagina,” is incorrect, and is […]
AAPC Knowledge Center

Nitrous Oxide for Vaginal delivery Billing Question

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My Office’s Anesthesia client just started using Nitrous Oxide for labor analgesia. How many base units should be billed with 01999 when Nitrous Oxide only was used for labor analgesia? If nitrous Oxide converts to an epidural with vaginal birth, should we bill with 01996 and start the time with the Nitrous Oxide administration?

Any help with this will be greatly appreciated.

Medical Billing and Coding Forum

Postpartum hemorrhage after vaginal delivery

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Patient had a vaginal delivery, 59409, and had uterine atony after the baby was delivered. Doctor performed fundal pressure and intrauterine exploration. The placenta had been delivered and then doctor gave patient Cytotec rectally twice as well as pitocin through her IV and hemabate intramuscularly.

Is the treatment for the postpartum hemorrhage included in the vaginal delivery or should that be billed separately? Which leads me to the only CPT I can find for postpartum hemorrhage is 59160 but curettage was not done.

TIA
Kam

Medical Billing and Coding Forum