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2025 CPT code 51845

Abdomino-vaginal vesical neck suspension, with or without endoscopic control (e.g., Stamey, Raz, modified Pereyra).

Follow current CPT coding guidelines and payer-specific coding policies.Documentation should be precise and comprehensive to support the code selection.

Modifiers may be applicable depending on the circumstances of the procedure (e.g., 22 for increased procedural services, 59 for distinct procedural service, etc.). Refer to CPT guidelines for appropriate modifier usage.

The procedure is medically necessary for women with stress urinary incontinence that significantly impacts their quality of life and has not responded to conservative management. The medical necessity should be supported by documentation demonstrating the failure of less invasive treatments (e.g., pelvic floor exercises, medication) and the presence of objective evidence of stress incontinence (e.g., positive stress test).

The urologist or surgeon is responsible for pre-operative evaluation, obtaining informed consent, performing the procedure, managing intraoperative complications, providing post-operative care, and ensuring proper documentation.

IMPORTANT:51990 (Laparoscopy, surgical; urethral suspension for stress incontinence) may be considered for laparoscopic approaches. 57288 (Sling operation for stress incontinence [e.g., fascia or synthetic]) is an alternative if a sling is used.Code 53899 (unlisted procedure, urinary system) might be necessary for novel techniques not clearly described by existing codes.

In simple words: This surgery helps women who leak urine when they cough, sneeze, laugh, or exercise. The doctor lifts and secures the bladder neck (where the bladder and urethra meet) to stop the leakage.It might involve a small incision above the pubic bone.

This procedure involves suspending the bladder neck in a female patient by anchoring tissues on each side of the bladder neck and suturing them to the abdominal fibrous tissue.It's performed to treat stress urinary incontinence, which is the inability to control urine during physical activities like coughing, sneezing, or exercise. The procedure may involve an incision in the suprapubic area of the abdomen to access the bladder neck, urethra, and supporting tissues. The goal is to restore the normal angle of the vesical neck and urethra, and stabilize the pelvic supporting tissues. This might include freeing the vesical neck, realigning it, and suturing the urethral-vesical neck and pelvic structures to the pubic bone and abdominal fibrous tissues. Endoscopic verification of suspension placement may be performed.Hemostasis, drain placement, and closure of the abdominal wound are final steps.

Example 1: A 55-year-old female patient presents with stress urinary incontinence following childbirth.An abdomino-vaginal vesical neck suspension (51845) is performed to correct the anatomical defect and restore continence., A 62-year-old female patient experiencing stress incontinence after hysterectomy undergoes an abdomino-vaginal vesical neck suspension (51845) using the Stamey technique.Post-operative cystoscopy is performed to ensure proper placement and absence of complications., A 48-year-old female patient with a history of pelvic organ prolapse and stress incontinence undergoes an abdomino-vaginal vesical neck suspension (51845) with endoscopic control to precisely position the sutures and verify anatomical correction.

* Comprehensive history and physical examination documenting the presence of stress urinary incontinence.* Pre-operative assessment, including urinalysis and urodynamic studies to evaluate the severity of incontinence and rule out other causes.* Operative report detailing the surgical technique, including the type of suspension used (e.g., Stamey, Raz, modified Pereyra), and any intraoperative complications.* Post-operative assessment, including follow-up visits to monitor for complications and assess continence status.* Imaging studies, if performed.

** The specific technique employed (e.g., Stamey, Raz, modified Pereyra) should be documented to support medical necessity and appropriate billing. The use of endoscopic control is also to be documented.Combined approaches (abdominal and vaginal) are also reflected in this code.

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