How To Use CPT Code 57555

CPT 57555 describes the excision of the cervical stump through a vaginal approach, along with anterior and/or posterior repair. 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 57555?

CPT 57555 is used to describe the surgical procedure of removing the cervical stump remaining after a previous subtotal hysterectomy. This procedure is performed through a vaginal approach and may also involve anterior and/or posterior repair. It is important to note that the cervical stump is the remaining portion of the cervix after a supracervical hysterectomy, where the inside of the cervix is cored out to prevent cancer within the endocervix or transformation zone.

2. Official Description

The official description of CPT code 57555 is: ‘Excision of cervical stump, vaginal approach; with anterior and/or posterior repair.’

3. Procedure

1. The patient is positioned in lithotomy position, and a speculum is inserted into the vagina.
2. The provider injects a local anesthetic mixed with a vasoconstrictor into the cervical stump to minimize bleeding.
3. A circular incision is made around the stump, and the provider dissects it away from the vaginal tissue using scissors.
4. Clamps are placed on the cardinal ligaments and uterosacral ligaments to further detach the cervical stump. If the round ligaments are attached to the stump, they are transected.
5. The cervical stump is then removed.
6. Anterior and/or posterior repair may be performed. For anterior repair, an incision is made into the anterior vaginal skin to expose the damaged pubocervical fascia. The provider plicates the fascia in the midline and sutures the strong tissue next to the weak edges of the deep vaginal wall. Excess vaginal skin is removed, and the incision is closed with dissolving stitches. For posterior repair, an incision is made in the posterior vaginal wall, and the provider plicates the fascia, bringing the edges together and suturing them. Excess vaginal wall tissue is removed, and repair of the perineum may also be performed.
7. The incision made by removing the cervical stump is closed with sutures.
8. Bleeding is controlled with electrocautery and sutures, and vaginal packing may be added.

4. Qualifying circumstances

CPT 57555 is performed when a patient has previously undergone a subtotal hysterectomy and still has a cervical stump. This procedure is typically done when the patient also has a cystocele (prolapse of the bladder into the vagina) and/or a rectocele (bulging of rectal tissue into the vagina). The excision of the cervical stump is performed through a vaginal approach, and anterior and/or posterior repair may be necessary.

5. When to use CPT code 57555

CPT code 57555 should be used when a provider performs the excision of the cervical stump through a vaginal approach, along with anterior and/or posterior repair. It is important to note that this procedure is typically performed at a later time following a subtotal hysterectomy when the patient also has a cystocele or rectocele.

6. Documentation requirements

To support a claim for CPT 57555, the provider must document the following information:

• Patient’s previous subtotal hysterectomy
• Presence of a cervical stump
• Details of the excision procedure, including the vaginal approach
• Anterior and/or posterior repair, if performed
• Any additional procedures performed, such as repair of the perineum
• Details of the closure technique
• Control of bleeding
• Use of vaginal packing, if applicable

7. Billing guidelines

When billing for CPT 57555, ensure that the excision of the cervical stump is performed through a vaginal approach, and anterior and/or posterior repair is documented. It is important to note that CPT code 57555 should not be reported with other codes for excision procedures on the cervix uteri (57500-57558). Additional tips for reporting CPT code 57555 include considering the presence of a cystocele or rectocele and documenting any additional procedures performed, such as repair of the perineum.

8. Historical information

CPT code 57555 was added to the Current Procedural Terminology system on January 1, 1990. There have been no updates to the code since its addition.

9. Examples

1. A patient who previously underwent a subtotal hysterectomy presents with a cervical stump and a cystocele. The provider performs the excision of the cervical stump through a vaginal approach and repairs the cystocele.
2. A patient who previously underwent a subtotal hysterectomy presents with a cervical stump and a rectocele. The provider performs the excision of the cervical stump through a vaginal approach and repairs the rectocele.
3. A patient who previously underwent a subtotal hysterectomy presents with a cervical stump, a cystocele, and a rectocele. The provider performs the excision of the cervical stump through a vaginal approach and repairs the cystocele and rectocele.
4. A patient who previously underwent a subtotal hysterectomy presents with a cervical stump and a cystocele. The provider performs the excision of the cervical stump through a vaginal approach and repairs the cystocele and performs perineorrhaphy.