It is difficult to know what CPT code to use for billing when my practice's physicians do a McCall culdoplasty during a vaginal or laparoscopic hysterectomy.
The McCall culdoplasty procedure is performed to support the vaginal cuff at the time of a vaginal hysterectomy by attaching the uterosacral and cardinal ligaments to the peritoneal surface with suture material such that, when tied, it draws toward the midline, helping to close off the cul-de-sac.
Vaginal procedures are McCall culdoplasty
, high uterosacral ligament suspension, iliococcygeus fascia suspension, Sacrospinous ligament fixation.
A McCall culdoplasty
or other similar procedure would not be feasible if the cervix is left in situ.
McCall culdoplasty: The standard for women without prolapse at hysterectomy
The McCall culdoplasty is the most commonly performed technique for prevention of prolapse at the time of vaginal hysterectomy; it also may be performed from an abdominal approach.
These include the vaginal procedures McCall culdoplasty
; plication of the uterosacral ligament; sacrospinous or prespinous fixation for vaginal vault prolapse; and Sacrocolpopexy (performed via an open procedure or laparoscopically).
I developed what I call a "babylap" that is one-third the size of a regular laparotomy that can be used to push the bowel and other organs away to gain better visualization while removing the ovaries and performing a McCall culdoplasty
The concept of utilizing the uterosacral ligaments to support the vaginal cuff and correct an enterocele is nothing new: As early as 1957, Milton McCall described what became known as the McCall culdoplasty
, in which sutures incorporated the uterosacral ligaments into the posterior vaginal vault to obliterate the cul-de-sac and suspend or support the vaginal apex at the time of vaginal hysterectomy.
The original McCall culdoplasty
begins with the placement of several rows (average of 3) of nonabsorbable suture ("internal" McCall sutures), starting at the left uterosacral ligament about 2 cm above its cut edge, and proceeding across the redundant cul-de-sac to terminate in the right uterosacral ligament.
Q I performed a McCall culdoplasty
following vaginal hysterectomy, but the insurance company denied payment for the culdoplasty, stating that this procedure is included in the hysterectomy.
The term "McCall culdoplasty
" isn't in the CPT book, so translate for your billers that you repaired an enterocele