CPT® Code 57289

Official Description

Pereyra procedure, including anterior colporrhaphy

Common Language Description

The Pereyra procedure, as described by CPT® Code 57289, is a surgical intervention aimed at addressing urinary incontinence, specifically in cases where the patient experiences an inability to control the release of urine. This condition often arises due to weakened pelvic support structures, leading to a displacement of the bladder, which can protrude through the vaginal wall, a condition known as cystocele. The procedure involves a combination of techniques to restore the anatomical integrity of the urethrovesical junction and repair the supporting tissues of the bladder. During the operation, a U-shaped incision is made around the vaginal opening, allowing access to the urethra and bladder junction. The surgeon meticulously opens the space alongside the urethra to facilitate the suturing of fascial tissues to the urethrovesical junction, thereby reinforcing this critical area. Additionally, an abdominal incision is made to facilitate the placement of a Pereyra ligature instrument, which is used to secure the urethrovesical junction to the rectus abdominis muscles. This dual approach not only addresses the incontinence but also corrects the cystocele, thereby enhancing the overall structural support of the pelvic floor. The procedure is comprehensive, combining both the surgical repair of the bladder's support structures and the reinforcement of the urethra, ultimately aiming to restore normal urinary function and improve the patient's quality of life.

1. Indications

The Pereyra procedure is indicated for patients experiencing urinary incontinence due to a weakened pelvic support system. This condition may manifest as an inability to control urination, often associated with a cystocele, where the bladder bulges into the vaginal wall. The procedure is typically recommended for individuals who have not responded to conservative treatments or pelvic floor exercises and are seeking surgical intervention to restore urinary function and improve quality of life.

Urinary Incontinence The primary indication for the Pereyra procedure is urinary incontinence, characterized by the involuntary leakage of urine.
Cystocele The procedure is also indicated for the repair of a cystocele, where the bladder protrudes into the vaginal wall, causing discomfort and urinary issues.

2. Procedure

The Pereyra procedure involves several critical steps to effectively address urinary incontinence and repair the cystocele. Initially, a U-shaped incision is made around the vaginal opening, strategically positioned between the urethra and the vagina. This incision allows the surgeon to access the underlying structures. Following this, the space on either side of the urethra is carefully opened to facilitate the suturing of the fascial tissues to the urethrovesical junction, reinforcing this area to prevent further incontinence.

Step 1: A U-shaped incision is created around the vaginal opening, providing access to the urethra and bladder junction.
Step 2: The surgeon opens the space on either side of the urethra, allowing for the suturing of fascial tissues to the urethrovesical junction.
Step 3: An incision is made in the abdomen above the pubis to facilitate the placement of the Pereyra ligature instrument.
Step 4: The Pereyra ligature instrument is inserted through the abdominal incision and guided down through the tissues on either side of the midline until it reaches the sutured tissue.
Step 5: Sutures are threaded into the instrument and brought back out through the abdominal incision.
Step 6: The urethrovesical junction is elevated by pulling on the sutures, which are then secured around the rectus abdominis muscle.
Step 7: Finally, anterior colporrhaphy is performed to repair the cystocele, addressing the bulging of the vaginal wall.

3. Post-Procedure

After the Pereyra procedure, 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 often advised to avoid heavy lifting and strenuous activities for a specified period. Follow-up appointments are essential to assess the surgical site and ensure proper healing. Additionally, patients may receive guidance on pelvic floor exercises to further support recovery and improve urinary function.

Short Descr	REPAIR BLADDER & VAGINA
Medium Descr	PEREYRA PX W/ANTERIOR COLPORRHAPHY
Long Descr	Pereyra procedure, including anterior colporrhaphy
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

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).
CR	Catastrophe/disaster related
GC	This service has been performed in part by a resident under the direction of a teaching physician