How To Use CPT Code 57284

CPT 57284 describes the repair of a paravaginal defect using an open abdominal approach, including the repair of a cystocele if performed. 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 57284?

CPT 57284 can be used to describe the surgical repair of a paravaginal defect using an open abdominal approach. This procedure involves closing the defect and may also include the repair of a cystocele, which is the drooping of the bladder into the vagina. It is important to note that CPT 57284 should not be reported in conjunction with certain other codes, such as 51840, 51841, 51990, 57240, 57260, 57265, 58152, and 58267.

2. Official Description

The official description of CPT code 57284 is: ‘Paravaginal defect repair (including repair of cystocele, if performed); open abdominal approach.’

3. Procedure

1. The patient is placed under general anesthesia and positioned in the supine position.
2. The physician opens the peritoneum above the bladder and behind the pubic bone to access the space of Retzius.
3. The physician extends the dissection to expose the arcus tendineus fascia pelvis on both sides.
4. Sutures are placed along the side of the vagina through the pubocervical fascia and brought through the obturator internus muscle above the arcus tendineus fascia pelvis.
5. The sutures are tied to close the defect, and the fascia and skin wounds are closed.
6. If a cystocele is present, the physician may also incise the vaginal wall and repair the area to provide better support to the bladder.

4. Qualifying circumstances

CPT 57284 is performed on patients with a paravaginal defect, which is a loss of support of the arcus tendineus fascia pelvis. This condition can lead to the prolapse of the bladder and urethra, resulting in a cystocele or urethrocystocele. The procedure is performed using an open abdominal approach and may include the repair of a cystocele if necessary.

5. When to use CPT code 57284

CPT code 57284 should be used when a paravaginal defect repair is performed using an open abdominal approach. It is important to note that this code should not be reported with codes that include bladder or urethral repair, such as a Marshall Marchetti Krantz procedure, a Burch procedure, or a laparoscopic urethral suspension. Additionally, codes for anterior colporrhaphy, which is done to repair a cystocele, should not be reported with CPT 57284.

6. Documentation requirements

To support a claim for CPT 57284, the physician must document the following information:

• Diagnosis of a paravaginal defect
• Description of the procedure performed, including the repair of a cystocele if applicable
• Date of the procedure
• Details of the surgical approach used
• Any additional procedures performed during the same operative session
• Signature of the physician performing the procedure

7. Billing guidelines

When billing for CPT 57284, ensure that the procedure is performed using an open abdominal approach and includes the repair of a paravaginal defect and possibly a cystocele. It is important to note that certain codes, such as 51840, 51841, 51990, 57240, 57260, 57265, 58152, and 58267, should not be reported in conjunction with CPT 57284. It is also important to follow any specific guidelines provided by payers regarding the reporting of this code.

8. Historical information

CPT 57284 was added to the Current Procedural Terminology system on January 1, 1996. On January 1, 2008, the code description was updated to include the repair of cystocele, stress urinary incontinence, and/or incomplete vaginal prolapse.

9. Examples

1. A physician performs a paravaginal defect repair using an open abdominal approach, including the repair of a cystocele, for a patient with a prolapsed bladder.
2. A surgeon performs a paravaginal defect repair using an open abdominal approach, including the repair of a cystocele, for a patient with a paravaginal defect and stress urinary incontinence.
3. A gynecologist performs a paravaginal defect repair using an open abdominal approach, including the repair of a cystocele, for a patient with incomplete vaginal prolapse.
4. A urologist performs a paravaginal defect repair using an open abdominal approach, including the repair of a cystocele, for a patient with a paravaginal defect and urethrocystocele.
5. A pelvic reconstructive surgeon performs a paravaginal defect repair using an open abdominal approach, including the repair of a cystocele, for a patient with a paravaginal defect and enterocele.
6. A gynecologic oncologist performs a paravaginal defect repair using an open abdominal approach, including the repair of a cystocele, for a patient with a paravaginal defect and ovarian cancer.