CPT® Code 74775

1. Indications

The perineogram is indicated for the evaluation of specific conditions and anomalies within the pelvic region. The following are the primary indications for performing this procedure:

• Anorectal Angle Anomalies These anomalies can lead to fecal incontinence, making it essential to assess their extent and impact on function.
• Pelvic Floor Anomalies The procedure helps in identifying various structural issues within the pelvic floor that may contribute to dysfunction.
• Vaginal Anomalies The perineogram is utilized to evaluate any abnormalities present in the vaginal structure.
• Rectocele This condition involves the protrusion of the rectum into the vaginal wall, which can be assessed through this imaging technique.
• Enterocele The procedure aids in identifying the presence of an enterocele, which is a herniation of the small intestine into the vaginal canal.
• Rectal Prolapse The perineogram can help visualize and assess the extent of rectal prolapse, providing critical information for treatment decisions.

2. Procedure

The perineogram procedure involves several detailed steps to ensure accurate imaging and assessment of the pelvic region. The following outlines the procedural steps:

• Step 1: Preparation and Contrast Injection Initially, the patient is prepared for the procedure, and nonionic contrast material is injected into the peritoneum. This step is performed under fluoroscopic guidance to ensure precise placement of the contrast agent.
• Step 2: Radiographic Imaging Following the injection of the contrast material, anteroposterior (AP) and lateral radiographs are obtained. These initial images provide a baseline view of the pelvic structures and help in identifying any immediate anomalies.
• Step 3: Barium Paste Enema Administration A barium paste enema is then administered to the patient. This step is crucial for enhancing the visibility of the rectal area during subsequent imaging.
• Step 4: Liquid Barium Injection After the barium paste enema, liquid barium is injected into the vagina. This dual contrast approach allows for a comprehensive evaluation of both the vaginal and rectal structures.
• Step 5: Patient Positioning and Imaging The patient is positioned on a commode, and lateral radiographs are obtained again. These images are captured both at rest and during maximum anal squeeze to assess the functional dynamics of the pelvic floor.
• Step 6: Evacuation Observation The patient is instructed to evacuate the barium from the rectum while the physician observes the process on a video monitor. This observation is critical for assessing the functional aspects of the pelvic region.
• Step 7: Final Radiograph A final lateral radiograph is taken as the patient evacuates the barium. This concluding image provides additional insights into the pelvic anatomy and any anomalies present.

3. Post-Procedure

After the completion of the perineogram, patients may be monitored for any immediate reactions to the contrast material. It is important to provide instructions regarding hydration to help facilitate the elimination of the contrast from the body. Patients may also be advised to observe for any unusual symptoms following the procedure, such as abdominal discomfort or changes in bowel habits. Follow-up appointments may be scheduled to discuss the results of the imaging and any necessary further evaluations or treatments based on the findings.