How To Use CPT Code 57423

CPT 57423 describes the laparoscopic repair of a paravaginal defect, including the repair of a cystocele if necessary. 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 57423?

CPT 57423 is used to describe the laparoscopic repair of a paravaginal defect, which involves the restoration of support to the lateral attachments of the vagina. This procedure may also include the repair of a cystocele, a condition where the bladder droops into the vagina due to weakened support.

2. Official Description

The official description of CPT code 57423 is: ‘Paravaginal defect repair (including repair of cystocele, if performed), laparoscopic approach.’

3. Procedure

1. The patient is positioned in the dorsal lithotomy position, and the abdomen is prepped and draped.
2. A general anesthetic is administered to the patient.
3. The provider enters the abdominal cavity near the belly button using a Veress needle or an open incision.
4. A laparoscope is inserted to visualize the abdominal and pelvic contents.
5. The abdomen is insufflated with carbon dioxide gas to create a pneumoperitoneum.
6. Small incisions are made in the abdominal area to insert trocars, which allow for better visualization and the addition of surgical tools.
7. If performing robotic surgery, the robot is docked to the laparoscope.
8. The provider enters the peritoneum above the bladder and behind the pubic bone to access the space of Retzius.
9. The provider extends the dissection to expose the arcus tendineus fascia pelvis on both sides.
10. Sutures are placed along the side of the vagina through the pubocervical fascia and brought through the obturator internus muscle.
11. The sutures are tied to close the paravaginal defect.
12. If a cystocele is present, the provider incises the vaginal wall and sutures the pubocervical tissue to support the bladder.
13. The robot, laparoscope, and trocars are removed, and the small incisions are closed with sutures.

4. Qualifying circumstances

CPT 57423 is performed on patients with a paravaginal defect, which is a loss of support to the lateral attachments of the vagina. This condition can result in the prolapse of the bladder and urethra, leading to a cystocele or urethrocystocele. The procedure is performed using a laparoscopic approach, and it may include the repair of a cystocele if necessary.

5. When to use CPT code 57423

CPT code 57423 should be used when a laparoscopic repair of a paravaginal defect is performed, including the repair of a cystocele if necessary. It is important to note that CPT code 57423 should not be reported in conjunction with codes 49320, 51840, 51841, 51990, 57240, 57260, 58152, or 58267.

6. Documentation requirements

To support a claim for CPT code 57423, the provider must document the following information:

• Diagnosis of a paravaginal defect and the need for repair
• Specific details of the laparoscopic procedure performed
• Date of the procedure
• Start and end time of the procedure
• Any additional procedures performed, such as the repair of a cystocele
• Details of the closure of the paravaginal defect and any sutures used
• Signature of the provider performing the procedure

7. Billing guidelines

When billing for CPT code 57423, ensure that the procedure is performed using a laparoscopic approach. It is important to note that CPT code 57423 should not be reported with codes 51840, 51841, 51990, 57240, 57260, 58152, or 58267. Additionally, if a mesh or other prosthesis is inserted for the repair of a pelvic floor defect, use code 57267 in conjunction with code 57423. It is also important to note that a diagnostic laparoscopy (code 49320) is bundled with any laparoscopic procedure and should not be separately reported.

8. Historical information

CPT code 57423 was added to the Current Procedural Terminology system on January 1, 2008. There have been no updates to the code since its addition.

9. Examples

1. A patient undergoes a laparoscopic repair of a paravaginal defect, including the repair of a cystocele if necessary.
2. A provider performs a laparoscopic procedure to restore support to the lateral attachments of the vagina in a patient with a paravaginal defect.
3. A laparoscopic repair of a paravaginal defect is performed on a patient, with the additional repair of a cystocele.
4. A provider uses a laparoscopic approach to close a paravaginal defect and provide support to the vagina.
5. A patient undergoes a laparoscopic procedure to repair a paravaginal defect and restore normal anatomy.
6. A laparoscopic repair of a paravaginal defect is performed on a patient, with the simultaneous repair of a cystocele.