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The CPT® Code 51840 refers to the procedure known as anterior vesicourethropexy or urethropexy, which is commonly recognized by the names Marshall-Marchetti-Krantz or Burch procedure. This surgical intervention is primarily aimed at addressing urinary incontinence in women, a condition often resulting from the stretching of pelvic ligaments associated with vaginal wall prolapse. During the procedure, the surgeon makes an incision in the abdomen to gain access to the bladder neck and urethra, which are then carefully exposed. The technique involves suspending the prolapsed vaginal wall and urethra to restore proper anatomical positioning and function. To achieve this suspension, two sutures are strategically placed through the paravaginal fascia, positioned on either side of the urethrovesical junction and oriented perpendicular to the vaginal axis. These sutures are subsequently passed through supportive structures such as Cooper's ligament, pelvic fascia, or the pubic bone, and are tied securely to provide the necessary support to the bladder and urethra. In cases where additional support is deemed necessary, a second set of sutures may be introduced along the base of the bladder. This procedure is classified as a simple bladder suspension and is indicated for patients who have not undergone previous surgical interventions for this condition. For more complex cases, such as those involving a failed suspension procedure requiring secondary repair, the CPT® Code 51841 should be utilized instead.
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The anterior vesicourethropexy or urethropexy procedure (CPT® Code 51840) is indicated for the treatment of urinary incontinence in women, particularly when this condition is caused by the stretching of pelvic ligaments associated with vaginal wall prolapse. The following specific indications may warrant the performance of this procedure:
The anterior vesicourethropexy or urethropexy procedure involves several critical steps to ensure effective treatment of urinary incontinence. The following outlines the procedural steps as described:
Post-procedure care following an anterior vesicourethropexy or urethropexy is essential for optimal recovery. Patients are typically monitored for any immediate complications and may be advised on activity restrictions to promote healing. It is common for patients to experience some discomfort or pain in the abdominal area, which can be managed with prescribed pain relief medications. Follow-up appointments are crucial to assess the success of the procedure and to monitor for any signs of complications, such as infection or recurrence of incontinence. Patients may also receive guidance on pelvic floor exercises to strengthen the pelvic muscles and support recovery. Overall, the expected recovery period can vary, but many patients can return to normal activities within a few weeks, depending on individual healing and the complexity of the procedure performed.
| Short Descr | ATTACH BLADDER/URETHRA | Medium Descr | ANT VESICOURETHROPEXY/URETHROPEXY SMPL | Long Descr | Anterior vesicourethropexy, or urethropexy (eg, Marshall-Marchetti-Krantz, Burch); simple | Status Code | Active Code | Global Days | 090 - Major Surgery | PC/TC Indicator (26, TC) | 0 - Physician Service Code | Multiple Procedures (51) | 2 - Standard payment adjustment rules for multiple procedures apply. | Bilateral Surgery (50) | 0 - 150% payment adjustment for bilateral procedures does NOT apply. | Physician Supervisions | 09 - Concept does not apply. | Assistant Surgeon (80, 82) | 2 - Payment restriction for assistants at surgery does not apply to this procedure... | Co-Surgeons (62) | 1 - Co-surgeons could be paid, though supporting documentation is required... | Team Surgery (66) | 0 - Team surgeons not permitted for this procedure. | Diagnostic Imaging Family | 99 - Concept Does Not Apply | APC Status Indicator | Inpatient Procedures, not paid under OPPS | Type of Service (TOS) | 2 - Surgery | Berenson-Eggers TOS (BETOS) | P1G - Major procedure - Other | MUE | 1 | CCS Clinical Classification | 106 - Genitourinary incontinence procedures |
| 51 | Multiple procedures: when multiple procedures, other than e/m services, physical medicine and rehabilitation services or provision of supplies (eg, vaccines), are performed at the same session by the same individual, the primary procedure or service may be reported as listed. the additional procedure(s) or service(s) may be identified by appending modifier 51 to the additional procedure or service code(s). note: this modifier should not be appended to designated "add-on" codes (see appendix d). | 52 | Reduced services: under certain circumstances a service or procedure is partially reduced or eliminated at the discretion of the physician or other qualified health care professional. under these circumstances the service provided can be identified by its usual procedure number and the addition of modifier 52, signifying that the service is reduced. this provides a means of reporting reduced services without disturbing the identification of the basic service. note: for hospital outpatient reporting of a previously scheduled procedure/service that is partially reduced or cancelled as a result of extenuating circumstances or those that threaten the well-being of the patient prior to or after administration of anesthesia, see modifiers 73 and 74 (see modifiers approved for asc hospital outpatient use). | 59 | Distinct procedural service: under certain circumstances, it may be necessary to indicate that a procedure or service was distinct or independent from other non-e/m services performed on the same day. modifier 59 is used to identify procedures/services, other than e/m services, that are not normally reported together, but are appropriate under the circumstances. documentation must support a different session, different procedure or surgery, different site or organ system, separate incision/excision, separate lesion, or separate injury (or area of injury in extensive injuries) not ordinarily encountered or performed on the same day by the same individual. however, when another already established modifier is appropriate it should be used rather than modifier 59. only if no more descriptive modifier is available, and the use of modifier 59 best explains the circumstances, should modifier 59 be used. note: modifier 59 should not be appended to an e/m service. to report a separate and distinct e/m service with a non-e/m service performed on the same date, see modifier 25. | 78 | Unplanned return to the operating/procedure room by the same physician or other qualified health care professional following initial procedure for a related procedure during the postoperative period: it may be necessary to indicate that another procedure was performed during the postoperative period of the initial procedure (unplanned procedure following initial procedure). when this procedure is related to the first, and requires the use of an operating/procedure room, it may be reported by adding modifier 78 to the related procedure. (for repeat procedures, see modifier 76.) | 79 | Unrelated procedure or service by the same physician or other qualified health care professional during the postoperative period: the individual may need to indicate that the performance of a procedure or service during the postoperative period was unrelated to the original procedure. this circumstance may be reported by using modifier 79. (for repeat procedures on the same day, see modifier 76.) | 80 | Assistant surgeon: surgical assistant services may be identified by adding modifier 80 to the usual procedure number(s). | 82 | Assistant surgeon (when qualified resident surgeon not available): the unavailability of a qualified resident surgeon is a prerequisite for use of modifier 82 appended to the usual procedure code number(s). | AS | Physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery | GC | This service has been performed in part by a resident under the direction of a teaching physician | LT | Left side (used to identify procedures performed on the left side of the body) |
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