CPT® Code 58823

Deleted

1. Indications

The procedure described by CPT® Code 58823 is indicated for the drainage of pelvic abscesses, which may arise from various underlying conditions. The following are specific indications for performing this procedure:

• Ovarian Abscess - A localized collection of pus associated with an ovarian cyst or infection.
• Pericolic Abscess - An abscess that forms adjacent to the colon, often due to diverticulitis or other gastrointestinal infections.
• Pelvic Inflammatory Disease (PID) - In cases where PID leads to the formation of abscesses in the pelvic region.
• Post-Surgical Complications - Abscess formation following gynecological or abdominal surgeries.

2. Procedure

The procedure for the drainage of a pelvic abscess using CPT® Code 58823 involves several critical steps, which can be performed via either a transvaginal or transrectal approach:

• Transvaginal Approach - The physician begins by placing an ultrasound probe with a drainage catheter mounted in the transducer groove into the vagina. This allows for real-time imaging to locate the abscess accurately. Once the abscess site is identified, the catheter tip is positioned directly over the abscess. A stylet is then inserted through the catheter tip into the abscess cavity. Following this, a trocar is advanced into the center of the abscess to facilitate drainage. The abscess is completely drained, and the catheter may be removed. If prolonged drainage is necessary, the inner stylet is removed, and the catheter is connected to a drainage bag or wall suction to allow for continuous drainage.
• Transrectal Approach - In this method, the physician inserts a gloved finger into the rectum to palpate the abscess, which is done under separately reportable radiological guidance. This step is crucial for accurately locating the abscess. A catheter is then inserted into the rectum, with the tip positioned at the abscess site. Similar to the transvaginal approach, a stylet is inserted through the catheter tip into the abscess, followed by the advancement of a trocar into the abscess cavity. After the abscess is drained, the stylet is removed, and the catheter is attached to a drainage bag or wall suction. Alternatively, an introducer tube may be utilized to facilitate catheter placement.

3. Post-Procedure

After the drainage procedure is completed, the patient may require monitoring for any potential complications, such as bleeding or infection. If a catheter has been left in place for ongoing drainage, it is essential to ensure that it remains patent and is functioning correctly. Patients may be advised on care for the catheter site and signs of infection to watch for during recovery. Follow-up imaging may be necessary to confirm the complete resolution of the abscess and to assess the effectiveness of the drainage procedure.