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The procedure described by CPT® Code 51990 refers to a laparoscopic surgical technique known as urethral suspension for the treatment of stress incontinence. Stress incontinence is a condition characterized by involuntary leakage of urine during activities that increase abdominal pressure, such as coughing, sneezing, or exercise. The laparoscopic approach involves making small incisions in the abdomen, which minimizes tissue trauma and promotes quicker recovery compared to traditional open surgery. During the procedure, a laparoscope—a thin, lighted tube with a camera—is inserted through a small incision below the umbilicus, allowing the surgeon to visualize the internal structures on a monitor. Additional small incisions are made to facilitate the introduction of specialized surgical instruments. The surgeon inspects the intraperitoneal cavity and carefully dissects the space of Retzius to locate and elevate the paravaginal fascia. This is crucial for placing sutures that will support the urethra and bladder neck, thereby restoring proper anatomical positioning and function. The procedure aims to elevate the urethrovesical angle, providing stability to the bladder neck and reducing episodes of urinary leakage. The effectiveness of the suspension is confirmed through visual inspection, manual assessment, or cystoscopy before concluding the procedure and closing the incisions.
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The laparoscopic urethral suspension procedure is indicated for patients experiencing stress incontinence, which is characterized by involuntary urine leakage during physical activities that increase abdominal pressure. This condition may arise from various factors, including weakened pelvic floor muscles, previous childbirth, or surgical interventions that have affected the urinary tract. The procedure is typically recommended for individuals who have not responded adequately to conservative treatments, such as pelvic floor exercises or lifestyle modifications.
The laparoscopic urethral suspension procedure involves several key steps to ensure effective treatment of stress incontinence. Initially, the surgeon makes a small incision just below the umbilicus to introduce the laparoscope, which provides visualization of the surgical field. Following this, two or three additional small incisions are created in the abdomen to allow for the insertion of specialized surgical instruments. Once the instruments are in place, the surgeon inspects the intraperitoneal cavity to assess the surrounding structures and identify the space of Retzius. This area is carefully dissected to expose the paravaginal fascia, which is then elevated to facilitate the placement of sutures. Next, two endoscopic sutures are placed through the paravaginal fascia, one on each side of the urethrovesical junction, ensuring that they are oriented perpendicular to the vaginal axis. These sutures are then passed through Cooper's ligament and tied securely. This action elevates the urethrovesical angle, providing a supportive platform for the bladder neck. After the initial suspension is completed, the surgeon checks the adequacy of the suspension through visual inspection, manual assessment, or cystoscopy. If necessary, a second set of sutures may be placed along the base of the bladder to enhance support. Finally, the laparoscope and surgical instruments are removed, and the abdominal incisions are closed to complete the procedure.
After the laparoscopic urethral suspension procedure, patients are typically monitored for a short period to ensure there are no immediate complications. Post-procedure care may include pain management, instructions for activity restrictions, and guidance on urinary function. Patients are often advised to avoid heavy lifting and strenuous activities for a specified period to allow for proper healing. Follow-up appointments are essential to assess recovery and the effectiveness of the procedure, as well as to address any concerns or complications that may arise. It is important for patients to report any unusual symptoms, such as excessive pain or changes in urinary patterns, to their healthcare provider promptly.
| Short Descr | LAPARO URETHRAL SUSPENSION | Medium Descr | LAPAROSCOPY URETHRAL SUSPENSION STRESS INCONT | Long Descr | Laparoscopy, surgical; urethral suspension for stress incontinence | Status Code | Active Code | Global Days | 090 - Major Surgery | PC/TC Indicator (26, TC) | 0 - Physician Service Code | Multiple Procedures (51) | 2 - Standard payment adjustment rules for multiple procedures apply. | Bilateral Surgery (50) | 0 - 150% payment adjustment for bilateral procedures does NOT apply. | Physician Supervisions | 09 - Concept does not apply. | Assistant Surgeon (80, 82) | 2 - Payment restriction for assistants at surgery does not apply to this procedure... | Co-Surgeons (62) | 1 - Co-surgeons could be paid, though supporting documentation is required... | Team Surgery (66) | 0 - Team surgeons not permitted for this procedure. | Diagnostic Imaging Family | 99 - Concept Does Not Apply | APC Status Indicator | Hospital Part B services paid through a comprehensive APC | Type of Service (TOS) | 2 - Surgery | Berenson-Eggers TOS (BETOS) | P1G - Major procedure - Other | MUE | 1 | CCS Clinical Classification | 106 - Genitourinary incontinence procedures |
This is a primary code that can be used with these additional add-on codes.
| 49327 | Addon Code MPFS Status: Active Code APC N ASC N1 Laparoscopy, surgical; with placement of interstitial device(s) for radiation therapy guidance (eg, fiducial markers, dosimeter), intra-abdominal, intrapelvic, and/or retroperitoneum, including imaging guidance, if performed, single or multiple (List separately in addition to code for primary procedure) |
| 51 | Multiple procedures: when multiple procedures, other than e/m services, physical medicine and rehabilitation services or provision of supplies (eg, vaccines), are performed at the same session by the same individual, the primary procedure or service may be reported as listed. the additional procedure(s) or service(s) may be identified by appending modifier 51 to the additional procedure or service code(s). note: this modifier should not be appended to designated "add-on" codes (see appendix d). | AS | Physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery | 59 | Distinct procedural service: under certain circumstances, it may be necessary to indicate that a procedure or service was distinct or independent from other non-e/m services performed on the same day. modifier 59 is used to identify procedures/services, other than e/m services, that are not normally reported together, but are appropriate under the circumstances. documentation must support a different session, different procedure or surgery, different site or organ system, separate incision/excision, separate lesion, or separate injury (or area of injury in extensive injuries) not ordinarily encountered or performed on the same day by the same individual. however, when another already established modifier is appropriate it should be used rather than modifier 59. only if no more descriptive modifier is available, and the use of modifier 59 best explains the circumstances, should modifier 59 be used. note: modifier 59 should not be appended to an e/m service. to report a separate and distinct e/m service with a non-e/m service performed on the same date, see modifier 25. | 80 | Assistant surgeon: surgical assistant services may be identified by adding modifier 80 to the usual procedure number(s). | GC | This service has been performed in part by a resident under the direction of a teaching physician | 22 | Increased procedural services: when the work required to provide a service is substantially greater than typically required, it may be identified by adding modifier 22 to the usual procedure code. documentation must support the substantial additional work and the reason for the additional work (ie, increased intensity, time, technical difficulty of procedure, severity of patient's condition, physical and mental effort required). note: this modifier should not be appended to an e/m service. | 62 | Two surgeons: when 2 surgeons work together as primary surgeons performing distinct part(s) of a procedure, each surgeon should report his/her distinct operative work by adding modifier 62 to the procedure code and any associated add-on code(s) for that procedure as long as both surgeons continue to work together as primary surgeons. each surgeon should report the co-surgery once using the same procedure code. if additional procedure(s) (including add-on procedure(s) are performed during the same surgical session, separate code(s) may also be reported with modifier 62 added. note: if a co-surgeon acts as an assistant in the performance of additional procedure(s), other than those reported with the modifier 62, during the same surgical session, those services may be reported using separate procedure code(s) with modifier 80 or modifier 82 added, as appropriate. | 77 | Repeat procedure by another physician or other qualified health care professional: it may be necessary to indicate that a basic procedure or service was repeated by another physician or other qualified health care professional subsequent to the original procedure or service. this circumstance may be reported by adding modifier 77 to the repeated procedure or service. note: this modifier should not be appended to an e/m service. | 78 | Unplanned return to the operating/procedure room by the same physician or other qualified health care professional following initial procedure for a related procedure during the postoperative period: it may be necessary to indicate that another procedure was performed during the postoperative period of the initial procedure (unplanned procedure following initial procedure). when this procedure is related to the first, and requires the use of an operating/procedure room, it may be reported by adding modifier 78 to the related procedure. (for repeat procedures, see modifier 76.) | 79 | Unrelated procedure or service by the same physician or other qualified health care professional during the postoperative period: the individual may need to indicate that the performance of a procedure or service during the postoperative period was unrelated to the original procedure. this circumstance may be reported by using modifier 79. (for repeat procedures on the same day, see modifier 76.) | 82 | Assistant surgeon (when qualified resident surgeon not available): the unavailability of a qualified resident surgeon is a prerequisite for use of modifier 82 appended to the usual procedure code number(s). | XS | Separate structure, a service that is distinct because it was performed on a separate organ/structure | XU | Unusual non-overlapping service, the use of a service that is distinct because it does not overlap usual components of the main service |
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| 2011-01-01 | Changed | Medium description changed. |
| 2000-01-01 | Added | First appearance in code book in 2000. |
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