How To Use CPT Code 57270

CPT 57270 describes the repair of an enterocele using an abdominal approach. This article will cover the description, procedure, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information and billing examples.

1. What is CPT Code 57270?

CPT 57270 is used to describe the repair of an enterocele using an abdominal approach. This procedure involves the physician performing either a Halban or a Moschowitz repair of the vaginal wall over the area where the small bowel is prolapsing into the vaginal canal. The purpose of this procedure is to strengthen the vaginal wall and eliminate the enterocele.

2. Official Description

The official description of CPT code 57270 is: ‘Repair of enterocele, abdominal approach (separate procedure).’ This code is used when the physician performs a repair of an enterocele using an abdominal approach.

3. Procedure

1. The physician administers anesthesia and prepares the patient for the procedure.
2. An abdominal incision is made to access the abdomen.
3. The physician locates the enterocele and isolates it by dissecting it away from the vaginal wall.
4. The sac of the enterocele is opened, and the physician enters the peritoneal cavity.
5. The physician ensures that the small bowel is packed away to prevent any complications.
6. The weakness of the vaginal wall is repaired using either a Halban or a Moschowitz technique.
7. In the Halban procedure, longitudinal sutures are placed through the covering tissue of the sigmoid, into the deep peritoneum of the cul-de-sac, and up the posterior vaginal wall. The sutures are then tied together.
8. In the Moschowitz procedure, pursestring sutures are placed around the cul-de-sac, including the posterior vaginal wall, the right pelvic sidewall, the covering tissue of the sigmoid, and the left pelvic sidewall. The sutures are tied to ensure no small defects are present.
9. Bleeding is controlled, and the abdominal incision is closed with sutures. A Foley catheter may be placed for drainage.

4. Qualifying circumstances

CPT 57270 is performed on patients with an enterocele, which is the protrusion of the small intestines and perineum into the vaginal canal. This procedure is done using an abdominal approach and is considered a separate procedure. It should not be billed separately if performed in conjunction with a vaginal vault suspension procedure, as the structures used to suspend the vault will also eliminate the enterocele. The procedure can also be done in conjunction with an abdominal hysterectomy to prevent the formation of an enterocele.

5. When to use CPT code 57270

CPT code 57270 should be used when a physician performs a repair of an enterocele using an abdominal approach as a separate procedure. It should not be reported with other codes if it is performed in conjunction with a related procedure. Modifier 59 may be appended if the procedure is performed with an unrelated procedure and the documentation supports it as a separate procedure.

6. Documentation requirements

To support a claim for CPT code 57270, the physician must document the following information:

• Patient’s diagnosis of an enterocele
• Description of the repair technique used (Halban or Moschowitz)
• Date of the procedure
• Details of the procedure, including the steps performed
• Any additional procedures performed in conjunction with CPT code 57270
• Signature of the performing physician

7. Billing guidelines

When billing for CPT code 57270, ensure that the procedure is performed using an abdominal approach as a separate procedure. It should not be reported with other codes if performed in conjunction with a related procedure. Modifier 59 may be appended if the procedure is performed with an unrelated procedure and the documentation supports it as a separate procedure. Be cautious not to confuse modifier 59 with modifier 51, which is used for multiple procedures on the same anatomic site or related procedures.

8. Historical information

CPT code 57270 was added to the Current Procedural Terminology system on January 1, 1990. The only update to the code was its inclusion in the Inpatient Only (IPO) list for Medicare in 2017.

9. Examples

1. A physician performs a repair of an enterocele using an abdominal approach as a separate procedure.
2. A patient undergoes an abdominal repair of an enterocele in conjunction with an abdominal hysterectomy.
3. A physician performs a repair of an enterocele using an abdominal approach as a separate procedure, along with an unrelated procedure.
4. A patient undergoes an abdominal repair of an enterocele in conjunction with a vaginal vault suspension procedure.
5. A physician performs a repair of an enterocele using an abdominal approach as a separate procedure, with the documentation supporting it as a distinct procedural service.