Reimbursement Advisor

Enterocele repair via LAVH and McCall’s culdoplasty

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Q Our physician performed a laparoscopically assisted vaginal hysterectomy (LAVH) and McCall’s culdoplasty. What is the McCall’s, exactly, and can we bill for it?

A McCall’s culdoplasty is a vaginal-approach repair of an enterocele (CPT 57268) and is coded only if an enterocele was present and the sac removed.

In general, an enterocele is a peritoneal sac or space between the vagina and rectum that begins to prolapse after multiple pregnancies or after a long period of time due to gravity. When the enterocele causes pain and bulging, the surgeon will remove the sac during vaginal surgery. If documentation confirms the presence of the symptomatic enterocele, the payer will likely reimburse for it. Note, however, that you’ll have to add modifier -59 (distinct procedure) to 57268, since this is a CPT “separate procedure” that the payer normally bundles.

If the surgeon sews up the cul-de-sac at the time of the LAVH to prevent a future problem, it’s considered “tidying up” and preventive and, therefore, not separately billable.

Ms. Witt, former program manager in the Department of Coding and Nomenclature at the American College of Obstetricians and Gynecologists, is an independent coding and documentation consultant. Reimbursement Adviser reflects the most commonly accepted interpretations of CPT-4 and ICD-9CM coding. When in doubt on a coding or billing matter, check with your individual payer.

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