0USF0ZZ
Reposition Cul-de-sac to No Qualifier with No Device, Open Approach
Procedural Specifications
| Clinical Axis | Detail Definition |
|---|---|
| Section | 0 Medical and Surgical |
| Body System | U Female Reproductive System |
| Operation | S Reposition |
| Body Part | F Cul-de-sac |
| Approach | 0 Open |
| Device | Z No Device |
| Qualifier | Z No Qualifier |
Operation Definition
Moving to its normal location, or other suitable location, all or a portion of a body part
Procedure Overview
Reposition procedures involve surgically moving a female reproductive organ or structure to its normal anatomic location, or to another suitable location, without cutting away tissue or adding replacement material. This root operation is most often used for conditions where an organ has shifted out of place, such as uterine prolapse, or for procedures that relocate an ovary, such as ovarian transposition performed before pelvic radiation to protect fertility.
These procedures matter clinically because organ displacement in the pelvis can cause pain, urinary or bowel dysfunction, and infertility. Surgeons address this by suspending or anchoring the organ, sometimes using sutures to native tissue and sometimes attaching it to a nearby structure like the sacrum, but the code reflects the movement of the existing body part rather than any material that may be used to hold it there.
Anatomy & Axis Detail
Cul-de-sac
The cul-de-sac, or pouch of Douglas, is the peritoneal recess between the posterior uterus and the anterior rectum, and it can become obliterated or distorted by adhesions from endometriosis, pelvic inflammatory disease, or prior surgery, sometimes trapping the ovaries or bowel in an abnormal position. Reposition procedures in this space typically involve surgically freeing adherent structures and restoring the normal peritoneal architecture of the pouch rather than excising tissue. Because the rectum, uterosacral ligaments, and ureters converge in this confined area, dissection to correct cul-de-sac obliteration, such as in deep infiltrating endometriosis, carries meaningful risk of bowel or ureteral injury and demands careful anatomic orientation.
Approach: Open
Open approach means the surgeon cuts through skin, mucous membrane, or other tissue layers to physically expose the target site to view before performing the procedure. It gives direct visualization and hands-on access, distinguishing it from Percutaneous approaches where instruments pass through a small puncture without exposing the site. Open is typical for procedures needing wide access, such as most laparotomies.
Coding & Documentation
Coders assign a Reposition code when the operative report describes moving an organ or structure to correct its position, using language like suspension, fixation, transposition, or resuspension. The documentation should identify both the structure being repositioned and, where relevant, the anatomic landmark it is anchored to, since this can affect approach and code specificity.
A frequent mistake is coding Reposition when sutures or mesh were placed primarily to reinforce weakened tissue rather than to move an organ, which instead falls under Supplement. Another common error is failing to recognize that if sutures alone are used to anchor a structure with no added material, Reposition is correct even though a repair-sounding term may appear in the note; coders need to read past the surgeon's word choice to the actual mechanics described.