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CPT Code 57423 Endoscopy/Laparascopy Procedures on the Vagina

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Comprehensive coding accuracy is vital in surgical gynecology. CPT 57423 is used to report laparoscopic colpopexy combined with enterocele repair. This complex pelvic reconstructive procedure restores vaginal support and corrects herniation of the small bowel into the upper vaginal space. 

For OBGYN surgeons, precise coding and documentation are key to ensuring full compliance with payer and CMS standards while avoiding claim denials.

This guide summarizes CPT 57423 as defined by AAPC and CMS 2025 updates, focusing on the procedure’s correct reporting, documentation, modifier use, and reimbursement structure.

CPT 57423 – Description

Official Definition: “Laparoscopy, surgical, colpopexy (suspension of vaginal cuff), with repair of enterocele.”

This code represents a laparoscopic approach where the vaginal apex (vaginal cuff or vault) is suspended to a fixed pelvic structure such as the sacrum or uterosacral ligaments, and an enterocele-a herniation of the small bowel into the vaginal apex-is repaired during the same operation.

CPT 57423 differs from 57425 (sacrocolpopexy) because it involves enterocele repair and not a full suspension with graft or mesh to the sacrum. It also differs from 57415 (colpopexy without enterocele repair), as it specifically includes enterocele correction.

When to Use CPT 57423

Report CPT 57423 when a laparoscopic colpopexy and enterocele repair are performed together, and both components are integral to restoring pelvic support.

Typical indications include:

  • Vaginal vault prolapse with associated enterocele after hysterectomy.
  • An enterocele causes upper vaginal pressure, pelvic fullness, or bowel protrusion.
  • Combined pelvic floor relaxation with loss of apical vaginal support.
  • Recurrent enterocele following prior vaginal or abdominal repair.

Do not use 57423 when:

  • The enterocele is repaired alone (use 57425 if sacrocolpopexy performed, or 57268 if vaginal approach).
  • The colpopexy is done without enterocele repair (use 57415).
  • The approach is vaginal rather than laparoscopic (use 57282 or 57283).

Coding and Billing Guidelines

Under CMS and AAPC 2025 updates, CPT 57423 is classified as a major laparoscopic pelvic reconstructive procedure with a 90-day global period.

Coding notes:

  • This code represents a single, inclusive service for both procedures not report separate codes for enterocele repair or colpopexy when performed laparoscopically in the same session.
  • If other unrelated laparoscopic pelvic procedures (such as adnexal surgery) are performed, apply appropriate modifiers and verify NCCI edit exceptions.
  • Ensure that operative documentation specifies both colpopexy and enterocele repair to justify the selection of CPT 57423.
  • Commercial payers commonly require preauthorization due to the reconstructive nature of the procedure.

Reimbursement Information

According to the 2025 Medicare Physician Fee Schedule, CPT 57423 continues to carry a higher relative value than colpopexy alone due to the additional enterocele repair component.

Reimbursement details:

  • Global period: 90 days
  • Site of service: Hospital or ambulatory surgical center
  • Multiple procedure rule: Reduction applies when billed with another major surgery
  • Prior authorization: Frequently required for commercial payers
  • ASC facility payment: Moderate-to-high tier, depending on region and payer

Because reimbursement can vary significantly among carriers, practices should confirm regional and payer-specific rates before submitting a bill.

Modifiers

Use modifiers only when supported by documentation:

  • Modifier 59 (or XS): To denote a distinct laparoscopic service when performed with unrelated procedures.
  • Modifier 51: For multiple major surgical services in one session.
  • Modifier 54 / 55: For split surgical and postoperative care.
  • Modifier 52: When the procedure is partially reduced.

Avoid using modifiers unless a clear clinical justification exists in the operative record.

Documentation Requirements

Precise documentation is critical for compliance and to support the use of CPT 57423. Operative notes should include:

  • Preoperative and postoperative diagnoses.
  • Laparoscopic approach confirmation.
  • Description of the enterocele repair and method of closure.
  • Type of colpopexy performed and fixation site (uterosacral, sacrospinous, etc.).
  • Intraoperative findings and anatomical corrections.
  • Any additional laparoscopic procedures performed.
  • Postoperative management and follow-up plan.

The documentation must clearly identify both procedures (colpopexy and enterocele repair) as distinct and completed laparoscopically.

Example Scenarios

Scenario 1:

A post-hysterectomy patient presents with vaginal vault prolapse and enterocele. Laparoscopic suspension of the vaginal cuff is performed along with closure of the enterocele sac. → Report CPT 57423.

Scenario 2:

A patient with vaginal apex prolapse and small bowel herniation undergoes laparoscopic enterocele repair with vaginal cuff fixation to the uterosacral ligaments. → Report CPT 57423.

Scenario 3:

If enterocele repair is performed vaginally instead of laparoscopically, report 57268 (vaginal enterocele repair), not 57423.

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Through detailed coding validation and payer-specific expertise, BillingFreedom helps OBGYN practices improve claim accuracy, minimize rejections, and maintain audit readiness. Our consistent focus on compliance and reimbursement integrity supports every stage of the OBGYN revenue cycle - from surgical coding to payment posting.

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