Summary & Overview
CPT 57265: Vaginal Repair of Pelvic Organ Prolapse with Enterocele
CPT code 57265 represents a vaginal approach surgical repair of weakened vaginal walls that support the bladder, rectum and small bowel, and includes repair of an enterocele when present. This pelvic reconstructive procedure is a key code for urogynecology and gynecologic surgery, affecting hospital and ambulatory surgery reimbursement and tracking of pelvic organ prolapse care across the US. It matters nationally because it captures a common, resource-intensive corrective surgery performed for symptomatic pelvic organ prolapse and enterocele.
Key payers discussed in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare and Medicare. Readers will find a concise clinical context for the procedure, typical sites of service, common billing modifiers (listed separately), and guidance on what clinical documentation commonly supports use of the code. The publication outlines typical utilization patterns, coding considerations tied to the vaginal approach and concurrent cystourethroscopy, and provides benchmarks and policy updates relevant to national payers. The content is intended to inform coding managers, billing staff, and clinical leaders about appropriate capture of the service and the contexts in which CPT code 57265 is applied.
Billing Code Overview
CPT code 57265 describes a vaginal approach surgical repair of pelvic support defects where the vaginal walls that support the bladder, rectum, and small bowel are weakened. The procedure repairs defects in the vaginal wall to restore support for the bladder, rectum and small intestine, and explicitly includes repair of an enterocele when the small intestine and perineum protrude into the vaginal canal. The description notes that the provider may perform cystourethroscopy during the same encounter to examine the bladder and urethra.
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Service type: Pelvic reconstructive surgery (vaginal repair of pelvic organ prolapse)
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Typical site of service: Hospital operating room or ambulatory surgery center, performed via a vaginal approach
Clinical & Coding Specifications
Clinical Context
A 62-year-old multiparous woman presents with symptomatic pelvic organ prolapse causing vaginal bulge, pelvic pressure, and urinary dysfunction. On exam she has anterior vaginal wall descent with cystocele, posterior wall descent with rectocele, and an enterocele. Conservative measures including pessary and pelvic floor therapy were attempted without adequate relief. The surgeon schedules a transvaginal repair to restore support to the anterior and posterior vaginal walls and to reduce and repair the enterocele. Preoperative evaluation includes history and physical, urinalysis, possible urodynamic testing if indicated, and informed consent discussing possible cystourethroscopy during the case. The procedure is performed in an ambulatory surgery center or hospital operating room under general, regional, or monitored anesthesia. Intraoperative steps include vaginal wall incisions, dissection to expose fascial defects, plication or repair of pubocervical and rectovaginal fascia, reduction and repair of enterocele sac, and placement of supporting sutures. Cystourethroscopy may be performed intraoperatively to evaluate the bladder and urethra for injury or concurrent pathology. Postoperative care includes routine recovery monitoring, voiding trial, pain control, activity restrictions, and follow-up to assess anatomic outcome and urinary function.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
00 | No modifier; standard reporting | Use for routine reporting when no special circumstances apply |