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The CPT® Code 57250 refers to a surgical procedure known as posterior colporrhaphy, specifically aimed at repairing a rectocele, which may be performed with or without an additional procedure called perineorrhaphy. A rectocele is a condition characterized by the protrusion of the rectum into the vaginal wall, resulting from a weakening of the anterior perirectal fascia. This weakening can lead to discomfort and various complications for the patient. The procedure involves making a transverse incision in the vaginal mucosa at the posterior fold of the labia minora, also known as the posterior fourchette. Through this incision, the surgeon dissects the posterior vaginal mucosa away from the perirectal fascia to access the rectocele. If perineorrhaphy is indicated, a second incision is made in the perineal body to facilitate the repair. The surgical steps include exposing and reducing the rectocele, placing sutures to secure the levator ani muscles, and meticulously closing the vaginal wall and perineal body to restore anatomical integrity. This procedure is essential for alleviating symptoms associated with rectocele and improving the quality of life for affected individuals.
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The posterior colporrhaphy procedure, coded as CPT® 57250, is indicated for patients experiencing a rectocele, which is the herniation of the rectum through the vaginal wall. This condition often results from weakened pelvic support structures and can lead to symptoms such as pelvic pressure, discomfort during intercourse, and difficulties with bowel movements. The procedure may also be indicated in cases where perineorrhaphy is necessary to address additional perineal support issues.
The procedure for posterior colporrhaphy involves several critical steps to ensure effective repair of the rectocele. Initially, a transverse incision is made in the vaginal mucosa at the posterior fold of the labia minora, known as the posterior fourchette. This incision allows access to the underlying tissues. Following this, the surgeon carefully dissects the posterior vaginal mucosa away from the perirectal fascia, which is essential for exposing the rectocele. If a perineorrhaphy is indicated, a second incision is made in the perineal body, where a triangular section of tissue is excised to reveal the bulbocavernosus muscle. Once the rectocele is adequately exposed, the surgeon reduces it to visualize the margins of the levator ani muscles. Sutures are then placed from the apical margin of the levator ani to the posterior fourchette, securing the tissue in place. After trimming any excessive vaginal mucosa, the surgeon closes the perirectal fascia, followed by the posterior vaginal wall. The hymenal ring is reconstructed to restore anatomical integrity. Finally, the vaginal mucosa is approximated to the perirectal fascia, and the defect in the perineal body is closed. Additional sutures are placed in the insertions of the bulbocavernosus muscle to complete the perineal body reconstruction. The procedure concludes with the layered closure of the subcutaneous tissues and skin, ensuring a secure and aesthetically pleasing result.
After the posterior colporrhaphy procedure, patients are typically monitored for any immediate complications. Post-operative care may include pain management, instructions for activity restrictions, and guidance on hygiene practices to promote healing. Patients are advised to avoid heavy lifting and strenuous activities for a specified period to ensure proper recovery. Follow-up appointments are essential to assess healing and address any concerns that may arise. It is also important for patients to report any signs of infection or unusual symptoms to their healthcare provider promptly.
| Short Descr | REPAIR RECTUM & VAGINA | Medium Descr | POST COLPORRHAPHY RECTOCELE W/WO PERINEORRHAPHY | Long Descr | Posterior colporrhaphy, repair of rectocele with or without perineorrhaphy | 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 | 129 - Repair of cystocele and rectocele, obliteration of vaginal vault |
This is a primary code that can be used with these additional add-on codes.
| 57267 | Female Edit Addon Code MPFS Status: Active Code APC N ASC N1 CPT Assistant Article Illustration for Code Insertion of mesh or other prosthesis for repair of pelvic floor defect, each site (anterior, posterior compartment), vaginal approach (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). | GC | This service has been performed in part by a resident under the direction of a teaching physician | 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). | 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 | 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. | 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. | 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. | 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.) | AG | Primary physician | AQ | Physician providing a service in an unlisted health professional shortage area (hpsa) | CC | Procedure code change (use 'cc' when the procedure code submitted was changed either for administrative reasons or because an incorrect code was filed) | CR | Catastrophe/disaster related | GV | Attending physician not employed or paid under arrangement by the patient's hospice provider | GW | Service not related to the hospice patient's terminal condition | KX | Requirements specified in the medical policy have been met | SA | Nurse practitioner rendering service in collaboration with a physician | SG | Ambulatory surgical center (asc) facility service | XP | Separate practitioner, a service that is distinct because it was performed by a different practitioner | 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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