CPT Code 59325 Abdominal Cerclage of the Cervix (Repair Procedures for Maternity Care and Delivery)

CPT 59325 is officially defined by the American Medical Association (AMA) as “Cervical cerclage, abdominal (during pregnancy).”

This code describes a surgical procedure performed through the abdominal approach to reinforce a weak or incompetent cervix during pregnancy. The goal is to prevent miscarriage or premature birth by placing a supportive suture around the cervix, helping it remain closed until term.

This code specifically applies when the abdominal route is used, distinguishing it from CPT 59320, which is used for vaginal cerclage procedures.

Description of the Procedure

During pregnancy, if a patient has a history of recurrent miscarriages or premature births due to cervical insufficiency, the provider may recommend a cerclage, a procedure that supports the cervix mechanically.

For CPT 59325, the provider:

• Makes an abdominal incision (either open or laparoscopic).
• Locates the cervix from the upper vaginal area.
• Places a strong suture or band around the cervical canal.
• Secures the suture tightly to prevent dilation.
• Closes the incision after verifying proper placement.

The surgery is typically performed during the second trimester (around 12–14 weeks of gestation) and may be done as a prophylactic or therapeutic intervention.

When to Use CPT 59325

Report CPT 59325 when:

• The patient is pregnant and requires reinforcement of a weak cervix via the abdominal route.
• The vaginal approach is not feasible due to scarring, prior failed vaginal cerclage, or anatomical limitations.
• The procedure is performed electively to prevent preterm cervical dilation or following partial cervical opening detected by ultrasound.

Do not report CPT 59325 when:

• The cerclage is performed vaginally (use CPT 59320).
• The patient is not pregnant at the time of surgery.
• The procedure involves removal of a cerclage (use CPT 59871).

Coding and Billing Guidelines

• Global Period: CPT 59325 carries a 90-day global period.
• Site of Service: Performed in a hospital or ambulatory surgical center.
• Anesthesia: Usually general or regional.
• Preauthorization: Recommended, especially when performed prophylactically.
• Documentation: Must include gestational age, surgical approach, and the reason the abdominal route was chosen.

Applicable Modifiers

• Modifier 22: For increased complexity (e.g., repeat abdominal cerclage, extensive adhesions).
• Modifier 51: When performed with another major procedure.
• Modifier 52: For reduced service (partial procedure).
• Modifier 59: If performed with unrelated procedures on the same day.

Documentation Requirements

Thorough and accurate documentation helps justify medical necessity and ensures clean claim submission. Include:

• Gestational age and clinical indication (history of cervical insufficiency, prior losses, etc.)
• Approach used – specify abdominal (open or laparoscopic).
• Reason for selecting abdominal over vaginal cerclage.
• Type of suture or material used.
• Intraoperative findings and postoperative plan.

Clinical Scenarios

Scenario 1 – Repeat Abdominal Cerclage After Vaginal Failure

A 34-year-old patient with a history of two mid-trimester losses previously had a vaginal cerclage that failed at 20 weeks. At 13 weeks in her current pregnancy, she undergoes an abdominal cerclage via laparotomy. The cervix is inaccessible vaginally, and a nonabsorbable suture is placed through the abdomen.

Correct Code: CPT 59325 - Abdominal cerclage of cervix during pregnancy.

Rationale: The vaginal route was not feasible; the abdominal approach was necessary for successful cervical reinforcement.

Scenario 2 – Laparoscopic Abdominal Cerclage for Anatomical Limitation

A 29-year-old patient with congenital cervical shortening is diagnosed with cervical incompetence at 12 weeks. The surgeon performs a laparoscopic cerclage using a Mersilene tape placed around the cervix via small abdominal ports.

Correct Code: CPT 59325 - Laparoscopic abdominal cerclage.

Rationale: Even though laparoscopic, it’s still considered an abdominal approach, making 59325 the correct code.

Scenario 3 – Emergency Cerclage Conversion

During pregnancy at 15 weeks, a patient with prior cesarean delivery and significant scarring presents with cervical dilation despite a prior vaginal cerclage attempt. The OB-GYN converts to an abdominal cerclage using an open incision to reinforce the internal os.

Correct Code: CPT 59325, Abdominal cerclage after failed vaginal attempt.

Rationale: The switch to abdominal access and active pregnancy status justify 59325 over 59320.

Common Coding Challenges

Confusing the Route of Access

Many denials happen when the operative note doesn’t clearly specify the surgical approach. The distinction between vaginal (59320) and abdominal (59325) is crucial. The coder should look for documentation that explicitly mentions an incision, trocar placement, or abdominal entry.

Missing Clinical Justification for the Abdominal Approach

Payers often question why the abdominal method was necessary. Ensure documentation includes reasons such as “failed vaginal cerclage,” “cervical scarring,” or “shortened cervix inaccessible vaginally.” Without that, reimbursement may be reduced or denied.

Incorrect Use of CPT for Nonpregnant Patients

CPT 59325 applies only during pregnancy. If performed before conception (e.g., interval cerclage), the service may fall under an unlisted code. Coders must confirm pregnancy status and gestational age from the operative note.

Omission of Gestational Age and Surgical Detail

Gestational age at the time of surgery affects medical necessity review. Always document “performed at X weeks gestation” and detail whether the approach was open or laparoscopic.

Modifier Oversight for Combined Procedures

In cases where the cerclage is performed with another abdominal surgery (such as myomectomy or adhesiolysis), add Modifier 51 to ensure proper sequencing and full payment for all covered services.

Payer Preauthorization Requirements

Because abdominal cerclage is often considered a high-cost or prophylactic procedure, many payers require prior approval. Missing preauthorization can lead to denials regardless of coding accuracy.

Reimbursement Information

• Average Medicare Reimbursement: Approximately $680–$850, depending on region and setting.
• Global Period: 90 days.
• Multiple Surgery Reduction: Applies if billed with other abdominal procedures.
• Preauthorization: Commonly required for prophylactic placements.

Always verify payer-specific policies before claim submission.

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