What is the CPT code for a marsupialization procedure of the Bartholin's gland to prevent reoccurrence of infection, where the gland is incised, drained, and the edges are sutured to create an open pouch?

CPT Coding for Bartholin's Gland Marsupialization

The correct CPT code for marsupialization of Bartholin's gland is 56440.

Understanding the Procedure and Code Selection

The patient presented with a recurrent Bartholin's gland infection that was previously treated with antibiotics. During this visit, the gynecologist performed a procedure that involved:

• Incising the gland
• Draining the material
• Suturing the edges to create an open pouch to prevent recurrence

This description precisely matches the definition of marsupialization, which creates a permanent opening by suturing the cyst wall to the surrounding tissue to prevent recurrence 1.

Analysis of Code Options:

1. 56405 - Incision and drainage of vulva or perineal abscess

   • This code only describes simple incision and drainage without creating a permanent opening

2. 56420 - Incision and drainage of Bartholin's gland abscess

   • This code describes simple drainage without marsupialization

3. 56440 - Marsupialization of Bartholin's gland cyst

   • This is the correct code as it specifically describes the procedure performed
   • Marsupialization involves creating a permanent opening by suturing the cyst wall to surrounding tissue

4. 56740 - Excision of Bartholin's gland or cyst

   • This code describes complete removal of the gland or cyst, which was not performed

Clinical Context and Procedure Details

Bartholin's glands are located in the posterior vestibule at the 4 and 8 o'clock positions of the vulva 1. When infected, they present with swelling, erythema, and tenderness that can extend into the entire labia minora.

The marsupialization procedure:

• Creates a permanent opening by suturing the cyst wall to the surrounding tissue
• Provides a more definitive solution for recurrent cysts compared to simple drainage
• Has advantages for preventing recurrence, which was the stated goal in this case
• Has comparable recurrence rates to Word catheter placement (10-12%) 2

Coding Pitfalls to Avoid

1. Don't confuse with simple I&D: Codes 56405 and 56420 are for simple incision and drainage procedures without the creation of a permanent opening through suturing.

2. Don't code as excision: Code 56740 involves complete removal of the gland or cyst, which is more extensive than the marsupialization described.

3. Documentation requirements: Ensure the operative note clearly documents:

   • Incision of the cyst
   • Drainage of contents
   • Suturing of the cyst wall to surrounding tissue to create a permanent opening

Clinical Considerations

The American College of Obstetricians and Gynecologists recommends that Bartholin gland cysts in women over 40 years warrant closer evaluation to rule out malignancy 1. For women of reproductive age, marsupialization is an appropriate treatment for recurrent Bartholin's gland cysts or abscesses.

Marsupialization has several advantages:

• More definitive for recurrent cysts
• Lower recurrence rates compared to simple drainage
• Creates a permanent drainage pathway

However, it does have some disadvantages compared to Word catheter placement:

• Longer procedure time
• Higher analgesic use post-procedure 1, 2

In this case, given the history of recurrent infection, marsupialization (56440) was the appropriate procedure and code selection.