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A paravaginal defect repair is a surgical procedure performed through the vaginal approach to correct a paravaginal defect, which is characterized by the loss of support of the arcus tendineus fascia pelvis (ATFP). This loss of support can lead to the prolapse of the bladder and urethra, resulting in conditions such as cystocele or cystourethrocele. During the procedure, the surgeon makes an incision in the anterior vaginal wall to access the retropubic space, also known as the space of Retzius. This access allows for the dissection of the bladder away from the vaginal epithelium, enabling the surgeon to expose the ATFP. The repair involves placing sutures at the site of the defect, which can be unilateral or bilateral, and securing them through the pubocervical fascia and the internal obturator muscle. The sutures are then tied to obliterate the defect, followed by the repair of the vaginal wall incisions. If a cystocele repair is necessary, it is included as part of this procedure. This surgical intervention aims to restore the normal anatomical position of the bladder and urethra, thereby alleviating symptoms associated with pelvic organ prolapse.
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The paravaginal defect repair procedure is indicated for patients experiencing pelvic organ prolapse, specifically when there is a paravaginal defect leading to conditions such as:
The paravaginal defect repair procedure involves several critical steps to ensure effective correction of the defect:
After the paravaginal defect repair, patients can expect a recovery period that may involve monitoring for any complications such as infection or excessive bleeding. Post-operative care typically includes pain management and instructions for activity restrictions to promote healing. Patients are advised to follow up with their healthcare provider to assess the success of the repair and to address any concerns that may arise during the recovery process. It is important for patients to adhere to the post-operative guidelines provided by their surgeon to ensure optimal recovery and outcomes.
| Short Descr | REPAIR PARAVAG DEFECT VAG | Medium Descr | PARAVAGINAL DEFECT REPAIR VAGINAL APPROACH | Long Descr | Paravaginal defect repair (including repair of cystocele, if performed); vaginal approach | 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) | 2 - Co-surgeons permitted and no documentation required if the two- specialty requirement is met. | 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 | 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). | 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. | 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. | 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). | 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). | GC | This service has been performed in part by a resident under the direction of a teaching physician | SA | Nurse practitioner rendering service in collaboration with a physician | 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 | Short description changed. |
| 2008-01-01 | Added | First appearance in code book in 2008. |
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