RE:
DOB:
L&I Claim No.
Dear:
We are writing this letter on behalf of NAME in referenced above workman’s compensation claim with
the Department of Labor and Industries. The conditions allowed on HIS/HER claim include urge
incontinence and stress incontinence.
NAME is recommending surgery that may consist of total vaginal hysterectomy with vaginal vault
suspension CPT 58260, anterior colporrhaphy CPT 57240, posterior colporrhaphy CPT 57250, repair
procedures on the vagina CPT 57283, and cystourethroscopy CPT 52000. The surgery procedure codes
are part of the recommended surgery for treatment of N81.11 Cystocele, midline, N39.46 Mixed
incontinence, and N39.41 Urge incontinence.
Surgery is recommended for pelvic organ prolapse which is a condition that refers to the bulging and
herniation of one or more pelvic organs into or out of the vagina. Pelvic organ prolapse occurs when the
muscles, ligaments, and fascia (a network of supporting tissue) that hold these organs in their correct
position becomes weakened. The main cause of damage to the nerves, ligaments, and muscles which
support the pelvic organs and may results from the following: pregnancy and childbirth which are
considered to be major factors leading to the weakening of the vagina and its supports, aging and
menopause may cause further weakening of the pelvic floor structures, conditions that cause excessive
pressure on the pelvic floor like obesity, chronic cough, chronic constipation, heavy lifting, and straining,
and finally some women may have an inherited risk for prolapse while some disease affect the strength
of connective tissue, e.g. Marfan syndrome and Ehlers-Danlos syndrome.
Symptoms of pelvic organ prolapse include a heavy dragging feeling in the vagina or lower back, feeling
of a lump in the vagina or outside the vagina, urinary symptoms such as slow urinary stream, a feeling
of incomplete bladder emptying, urinary frequency or urgent desire to pass urine, and urinary stress
incontinence, bowel symptoms such as difficulty moving the bowel or a feeling of not emptying
properly, or needing to press on the vaginal wall to empty the bowel, and discomfort during sexual
intercourse. NAME has a mixture of different symptoms listed above that explain her diagnosis codes of
N39.46 Mixed Incontinence, N39.41 Urge incontinence, and examinations verifying N81.11 Cystocele,
midline.
Pelvic organ prolapse may occur in the front wall of the vagina or anterior, back wall of the vagina or
posterior, the uterus and/or top of the vagina called apical compartment. Many women have a prolapse
in more than one compartment at the same time. The most common type of prolapse involves the
bladder and/or urethra building into the vagina which is referred to a cystocele. The non-surgical
treatment options for NAME have been attempted such as avoiding heavy lifting, chronic straining,
weight loss, symptom relief, medications, pessary of various sizes and shapes, and pelvic floor exercise.
The next step is surgical treatment options which were discussed above in detail pertaining to the most
appropriate surgical treatment for the main purpose of restoring the pelvic organs to their natural
position while retaining sexual function. Approximately 75% of women having vaginal surgery will have a
long-term cure of the prolapse symptoms. Recurrent prolapse may occur due to continued factors which
may have caused the initial prolapse e.g. chronic constipation and weak tissues.
As outline in the letter NAME symptoms, examinations, and previous failed treatments lead to a surgical
treatment option which NAME has recommended. The surgical treatment option NAME has
recommended based on NAME symptoms may consist of a total vaginal hysterectomy with vaginal vault
suspension, anterior and posterior colporrhaphy, various repair procedures on the vagina to
accommodate a total vaginal hysterectomy with vaginal vault suspension and anterior and posterior
colporrhaphy, and cystourethroscopy which allows NAME to have visualization to perform said surgical
procedures listed above.
Sincerely,