CPT® Code 59325

1. Indications

The cerclage of the cervix, as described by CPT® Code 59325, is indicated for several specific conditions and circumstances that may compromise the integrity of the cervix during pregnancy. These indications include:

• Incompetent Cervix - A condition where the cervix is unable to remain closed, leading to premature opening.
• History of Second Trimester Miscarriage - Previous miscarriages occurring in the second trimester may necessitate the procedure to prevent recurrence.
• Previous Cervical Surgeries - Surgeries such as loop electrical excision procedures or cone biopsies that may weaken the cervical structure.
• Cervical Injury - Any trauma or injury to the cervix that could lead to its inability to maintain closure during pregnancy.

2. Procedure

The procedure for cerclage of the cervix using the abdominal approach, as outlined in CPT® Code 59325, involves several critical steps to ensure the effective placement of the stitch. The following procedural steps are typically followed:

• Step 1: Anesthesia Administration - The patient is prepared for surgery, and appropriate anesthesia is administered to ensure comfort during the procedure.
• Step 2: Surgical Incision - A surgical incision is made in the lower abdomen, providing access to the uterus and cervix. This incision is carefully placed to minimize complications and facilitate the procedure.
• Step 3: Stitch Placement - A stitch is then placed through the lower part of the uterus. This stitch is strategically positioned to cinch the lower uterus and upper cervix together, providing the necessary support to prevent premature opening.
• Step 4: Closure of Incision - After the stitch is securely placed, the surgical incision in the abdomen is closed using standard suturing techniques, ensuring proper healing and minimizing scarring.

3. Post-Procedure

Following the cerclage procedure, patients are typically monitored for any signs of complications, such as infection or premature labor. It is essential for patients to follow up with their healthcare provider for regular assessments of cervical status and overall pregnancy health. Recovery may involve restrictions on physical activity, and patients are advised to report any unusual symptoms, such as cramping or bleeding, to their physician promptly. The cerclage may remain in place until the patient reaches a point in the pregnancy where the risk of cervical incompetence is reduced, often until around 36-37 weeks of gestation, at which point it may be removed if necessary.