How To Use CPT Code 57295

CPT 57295 describes the revision or removal of a prosthetic vaginal graft using a vaginal 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 57295?

CPT 57295 is used to describe the revision or removal of a prosthetic vaginal graft that was previously placed. This procedure is performed when the graft has eroded or when the tissue over the mesh has thinned and the mesh is now exposed. The provider uses a vaginal approach to revise or remove the graft.

2. Official Description

The official description of CPT code 57295 is: ‘Revision (including removal) of prosthetic vaginal graft; vaginal approach.’

3. Procedure

1. The patient is placed in the dorsal lithotomy position and anesthesia is administered.
2. A speculum is inserted into the vagina to inspect the location of the previously placed graft.
3. The provider determines whether the graft can be revised by placing additional sutures or if it should be completely excised.
4. If revision is possible, the provider excises the tissue around the surface lines of the graft.
5. If complete excision is necessary, the provider removes the entire graft.
6. The provider then closes the endopelvic fascia and the vaginal mucosa.
7. A Foley catheter is inserted and the vagina is packed with gauze.

4. Qualifying circumstances

CPT 57295 is performed on patients who have previously had a prosthetic vaginal graft placed and now require revision or removal. The procedure is necessary when the graft has eroded or when the tissue over the mesh has thinned and the mesh is exposed. The provider must use a vaginal approach to perform the revision or removal.

5. When to use CPT code 57295

CPT code 57295 should be used when a provider performs a revision or removal of a prosthetic vaginal graft using a vaginal approach. This code is appropriate when the graft has eroded or when the tissue over the mesh has thinned and the mesh is exposed. It is important to note that CPT code 57295 should only be reported for procedures performed in a hospital setting.

6. Documentation requirements

To support a claim for CPT code 57295, the provider must document the following information:

• Patient’s medical history and the need for revision or removal of the prosthetic vaginal graft
• Details of the procedure, including the use of a vaginal approach
• Date of the procedure
• Specific steps taken during the revision or removal
• Any complications or additional procedures performed
• Signature of the provider performing the procedure

7. Billing guidelines

When billing for CPT code 57295, ensure that the procedure is performed in a hospital setting. It is important to note that this code should not be reported for procedures performed in an office setting. Additionally, if the provider chooses to replace the graft with a new graft held in place with sutures, this should be included as part of the revision. It is recommended to review the CMS database for further guidance on reporting this procedure in different settings.

8. Historical information

CPT code 57295 was added to the Current Procedural Terminology system on January 1, 2006. There have been no updates or changes to the code since its addition.

9. Examples

1. A provider performs a revision of a prosthetic vaginal graft that has eroded for a patient who had the graft placed previously.
2. A patient presents with a thinning tissue over the mesh of a prosthetic vaginal graft, and the provider performs a complete excision of the graft using a vaginal approach.
3. A provider revises a prosthetic vaginal graft by placing additional sutures to address erosion and improve the patient’s condition.
4. A patient requires the removal of a prosthetic vaginal graft due to complications, and the provider performs the procedure using a vaginal approach.
5. A provider performs a revision of a prosthetic vaginal graft for a patient who experiences discomfort and exposure of the mesh.
6. A patient with a previously placed prosthetic vaginal graft requires revision due to erosion, and the provider performs the procedure using a vaginal approach.
7. A provider performs a complete excision of a prosthetic vaginal graft for a patient who experiences complications and exposure of the mesh.
8. A patient presents with thinning tissue over the mesh of a prosthetic vaginal graft, and the provider performs a revision by placing additional sutures to address the issue.
9. A provider performs a revision of a prosthetic vaginal graft for a patient who experiences discomfort and erosion of the graft.
10. A patient requires the removal of a prosthetic vaginal graft due to complications, and the provider performs the procedure using a vaginal approach.