How To Use CPT Code 57296

CPT 57296 describes the revision or removal of a prosthetic vaginal graft through an open 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 57296?

CPT 57296 can be used to describe the revision or removal of a prosthetic vaginal graft that was previously placed and has eroded or caused thinning of the tissue over the mesh, resulting in exposure. This code is used when the procedure is performed through an open abdominal approach.

2. Official Description

The official description of CPT code 57296 is: ‘Revision (including removal) of prosthetic vaginal graft; open abdominal approach.’

3. Procedure

1. The provider administers a general anesthetic and places the patient in the supine position.
2. An abdominal incision is made to access the pelvis.
3. The provider identifies the prosthetic vaginal graft, either by using their free hand or by placing an instrument into the vaginal cavity.
4. The peritoneum over the graft is opened, and the provider dissects and removes all or part of the graft material.
5. The provider ensures that the small bowel, rectum, and bladder are not attached to the graft or tissue.
6. The edges of the endopelvic fascia are sewn together, and the vaginal tissue is closed in layers.
7. The provider identifies and removes the attachment of the graft to a ligament, along with any sutures that held the graft in place.
8. The area where the graft previously lay is sutured.
9. The abdominal incision is closed, and vaginal packing with gauze may be applied to control bleeding.

4. Qualifying circumstances

CPT 57296 is performed when a prosthetic vaginal graft needs to be revised or removed due to erosion or thinning of the tissue over the mesh. The procedure is done through an open abdominal approach, and the patient must be placed under a general anesthetic. The provider must ensure that the small bowel, rectum, and bladder are not attached to the graft or tissue during the dissection.

5. When to use CPT code 57296

CPT code 57296 should be used when a provider performs a revision or removal of a prosthetic vaginal graft through an open abdominal approach. It is important to note that this code is not appropriate for procedures performed using a laparoscopic approach, as a different code (57426) should be used in those cases.

6. Documentation requirements

To support a claim for CPT 57296, the provider must document the following information:

• The reason for the revision or removal of the prosthetic vaginal graft
• The specific steps taken during the procedure, including the identification and removal of the graft material
• The date of the procedure
• The start and end time of the procedure
• Any complications or additional procedures performed
• The signature of the provider who performed the procedure

7. Billing guidelines

When billing for CPT 57296, ensure that the procedure is performed through an open abdominal approach and that the patient is under a general anesthetic. It is important to note that this code should not be reported with other codes such as CPT codes 98966 to 98968. Additionally, consider the location of the testing when coding for pulmonary function tests (PFTs) as they have both a professional and technical component.

8. Historical information

CPT 57296 was added to the Current Procedural Terminology system on January 1, 2007. It was later added to the Inpatient Only (IPO) list for Medicare in 2017.

9. Examples

1. A provider performs a revision of a prosthetic vaginal graft through an open abdominal approach due to erosion of the tissue over the mesh.
2. A patient undergoes the removal of a prosthetic vaginal graft that has caused thinning of the tissue, resulting in exposure.
3. A provider revises a prosthetic vaginal graft that was previously placed and has caused complications, requiring its removal.
4. A patient undergoes a revision of a prosthetic vaginal graft due to erosion and thinning of the tissue over the mesh, resulting in discomfort and pain.
5. A provider performs the removal of a prosthetic vaginal graft that has caused infection and inflammation in the surrounding tissue.
6. A patient undergoes a revision of a prosthetic vaginal graft through an open abdominal approach to address complications and improve their overall health and well-being.
7. A provider removes a prosthetic vaginal graft that has caused significant discomfort and has not provided the desired results.
8. A patient undergoes the revision of a prosthetic vaginal graft to address complications and improve their quality of life.
9. A provider performs the removal of a prosthetic vaginal graft that has caused erosion and exposure of the mesh, resulting in pain and discomfort.
10. A patient undergoes a revision of a prosthetic vaginal graft to address complications and improve their overall vaginal health.