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The CPT® Code 57220 refers to a surgical procedure known as a plastic operation on the urethral sphincter, which is performed via a vaginal approach. This procedure is commonly utilized to address stress incontinence, a condition characterized by involuntary leakage of urine during activities that increase abdominal pressure, such as coughing, sneezing, or exercise. The operation typically involves techniques such as Kelly urethral plication, which aims to reduce the diameter of the urethra to enhance its closure mechanism and improve urinary control. The procedure is executed through the vagina, allowing direct access to the urethral sphincter. The surgical steps include the placement of a tenaculum on the cervix, making a transverse incision, and carefully dissecting the vaginal mucosa to expose the underlying structures. This meticulous approach ensures that the bladder and urethra are adequately separated from the vaginal tissue, facilitating the placement of sutures that will plicate the urethral tissue. The ultimate goal of this procedure is to restore proper function to the urethral sphincter, thereby alleviating the symptoms of stress incontinence and improving the patient's quality of life.
© Copyright 2025 Coding Ahead. All rights reserved.
The procedure described by CPT® Code 57220 is indicated for the treatment of stress incontinence, which may arise from various factors such as childbirth, pelvic surgery, or aging. Stress incontinence is characterized by the involuntary loss of urine during physical activities that increase abdominal pressure. This condition can significantly impact a patient's quality of life, leading to social embarrassment and psychological distress. The plastic operation on the urethral sphincter aims to provide a surgical solution to restore urinary control and improve the patient's overall well-being.
The procedure begins with the physician placing a tenaculum on the cervix to stabilize the area. A transverse incision is then made at the junction of the vaginal mucosa and cervix, extending down to the pubovesical cervical fascia. This incision allows for access to the underlying structures. Following the incision, the vaginal mucosa is carefully dissected away from the pubovesical cervical fascia. The dissection continues until the bladder and urethra are adequately separated from the vaginal mucosa, allowing the surgeon to identify the urethral vesical angle. Once this anatomical landmark is located, a mattress suture is placed in the wall of the urethra along the lateral margin, approximately 1 cm below the urethral meatus. This suture is critical for the subsequent plication process. The urethral tissue is then inverted and plicated, with the suture tied securely to maintain the new position. Additional plication sutures are placed along the urethra, extending approximately 2 cm beyond the urethral vesical angle to ensure adequate support. After the plication is complete, the overlying tissues are reapproximated to restore the vaginal anatomy. Finally, a Foley or suprapubic catheter is placed to facilitate urinary drainage during the initial recovery period.
After the completion of the procedure, patients are typically monitored for any immediate complications. The placement of a Foley or suprapubic catheter allows for controlled urinary drainage, which is essential during the initial recovery phase. Patients may experience some discomfort or vaginal bleeding, which is generally expected and should resolve over time. Follow-up appointments are crucial to assess the surgical site, ensure proper healing, and evaluate the effectiveness of the procedure in alleviating stress incontinence symptoms. Patients are advised on activity restrictions and may receive guidance on pelvic floor exercises to support recovery and enhance urinary control.
| Short Descr | REVISION OF URETHRA | Medium Descr | PLASTIC URETHRAL SPHINCTER VAGINAL APPROACH | Long Descr | Plastic operation on urethral sphincter, vaginal approach (eg, Kelly urethral plication) | 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 | ASC Payment Indicator | Surgical procedure on ASC list in CY 2007; payment based on OPPS relative payment weight. | Type of Service (TOS) | 2 - Surgery | Berenson-Eggers TOS (BETOS) | P1G - Major procedure - Other | MUE | 1 | CCS Clinical Classification | 106 - Genitourinary incontinence procedures |
| 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. | 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). | 80 | Assistant surgeon: surgical assistant services may be identified by adding modifier 80 to the usual procedure number(s). | 58 | Staged or related procedure or service by the same physician or other qualified health care professional during the postoperative period: it may be necessary to indicate that the performance of a procedure or service during the postoperative period was: (a) planned or anticipated (staged); (b) more extensive than the original procedure; or (c) for therapy following a surgical procedure. this circumstance may be reported by adding modifier 58 to the staged or related procedure. note: for treatment of a problem that requires a return to the operating/procedure room (eg, unanticipated clinical condition), see modifier 78. | GC | This service has been performed in part by a resident under the direction of a teaching physician | XU | Unusual non-overlapping service, the use of a service that is distinct because it does not overlap usual components of the main service | 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.) | AS | Physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery | XS | Separate structure, a service that is distinct because it was performed on a separate organ/structure |
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| Pre-1990 | Added | Code added. |
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