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An enterocele repair is a surgical procedure aimed at correcting a specific type of hernia known as an enterocele. An enterocele occurs when a portion of the small intestine, along with the peritoneal sac, protrudes into the rectovaginal space, which is the area located between the back wall of the vagina and the front wall of the rectum. This condition can lead to various complications, including discomfort and functional issues. The procedure described by CPT® Code 57270 refers to the repair of an enterocele through an abdominal approach, distinguishing it from other methods, such as the vaginal approach outlined in CPT® Code 57268. During the abdominal approach, a surgical incision is made in the lower abdomen to access the affected area. The peritoneum is then incised at the vaginal cuff, allowing the surgeon to identify and expose the enterocele sac. The procedure involves incising the sac, repositioning the small bowel back into the abdominal cavity, and subsequently ligating and resecting the sac. The repair of the endopelvic fascia is a critical component of this procedure, which can be accomplished using various techniques, such as the Halban or Moschcowitz repair methods. These techniques aim to reinforce the pelvic support structures and prevent the recurrence of the enterocele, ensuring a more stable anatomical position of the pelvic organs.
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The repair of an enterocele via an abdominal approach is indicated for patients presenting with the following conditions:
The procedure for repairing an enterocele through an abdominal approach involves several critical steps:
Post-procedure care following an enterocele repair via the abdominal approach typically includes monitoring for any complications, managing pain, and ensuring proper healing of the surgical site. Patients may be advised to avoid strenuous activities and heavy lifting for a specified period to promote recovery. Follow-up appointments are essential to assess the surgical site and ensure that the repair is healing appropriately. Additionally, patients may receive guidance on pelvic floor exercises to strengthen the area and prevent recurrence of the enterocele.
| Short Descr | REPAIR OF BOWEL POUCH | Medium Descr | REPAIR ENTEROCELE ABDOMINAL APPROACH SPX | Long Descr | Repair of enterocele, abdominal approach (separate procedure) | 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 | Inpatient Procedures, not paid under OPPS | 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 |
| 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). | XU | Unusual non-overlapping service, the use of a service that is distinct because it does not overlap usual components of the main service | 52 | Reduced services: under certain circumstances a service or procedure is partially reduced or eliminated at the discretion of the physician or other qualified health care professional. under these circumstances the service provided can be identified by its usual procedure number and the addition of modifier 52, signifying that the service is reduced. this provides a means of reporting reduced services without disturbing the identification of the basic service. note: for hospital outpatient reporting of a previously scheduled procedure/service that is partially reduced or cancelled as a result of extenuating circumstances or those that threaten the well-being of the patient prior to or after administration of anesthesia, see modifiers 73 and 74 (see modifiers approved for asc hospital outpatient use). | 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. | 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. | 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.) | 80 | Assistant surgeon: surgical assistant services may be identified by adding modifier 80 to the usual procedure number(s). | AS | Physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery | CR | Catastrophe/disaster related | GC | This service has been performed in part by a resident under the direction of a teaching physician | XS | Separate structure, a service that is distinct because it was performed on a separate organ/structure |
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