Appendix 1. Index Procedure Codes

Appendix 1. Index Procedure Codes Outpatient CPT Inpatient ICD-9 Prolapse Repair 57120 Colpocleisis 69.21 Uterine suspension 57240 Repair of cystocele 69.22 Other uterine suspension 57250 Repair of rectocele 69.23 Vaginal repair of chronic inversion of uterus 57260 Repair of cystocele and rectocele 69.29 Other repair of uterus and supporting structures 57265 Repair of cystocele, rectocele, and enterocele 69.98 Other operation on supporting structure of the uterus 57268 Repair of enterocele via vaginal approach 70.50 Repair of cystocele and rectocele 57282 Colpopexy via extraperitoneal vaginal approach 70.51 Repair of cystocele 57283 Colpopexy via intraperitoneal vaginal approach 70.52 Repair of rectocele 57284 Paravaginal defect repair 70.53 Repair of cystocele and rectocele with graft* 58152 Hysterectomy and cystocele 70.54 Repair of cystocele with graft* 58267 Hysterectomy and cystocele 70.55 Repair of rectocele with graft* 58270 Hysterectomy with repair of enterocele 70.62 Vaginal reconstruction 58280 Hysterectomy Vaginal and partial vaginectomy with repair of 70.64 Vaginal reconstruction with mesh* enterocele 58292 Hysterectomy Vaginal (>250 g) with removal tube +/− ovary 70.77 Vaginal suspension and repair of enterocele 58293 Hysterectomy vaginal (>250 g) with colpo-urethrocystopexy 70.78 Vaginal suspension with graft* 58294 Hysterectomy with repair of enterocele 70.80 Colpocleisis 58400 Uterine suspension 70.92 Other operation of the cul-de-sac (includes obliteration of cul-de-sac and enterocele repair) 58410 Uterine suspension with presacral sympathectomy 70.93 Other operation of the cul-de-sac with graft* 70.94 Other operation of the cul-de-sac with biologic graft 70.95 Other operation of the cul-de-sac with synthetic mesh* Incontinence Procedure 51715 Cystoscopic injection of urethral bulking agent 57.85 Cystourethroplasty 51840 Retropubic urethral suspension 57.89 Bladder suspension not otherwise specified 51845 Needle suspension 59.30 Plication of the urethrovesical junction 57288 Mid-urethral sling 59.40 Suprapubic sling operation 57289 Pereyra procedure 59.50 Retropubic urethral suspension 59.60 Paraurethral suspension 59.70 Other repair for stress urinary incontinence Hysterectomy Procedure 58150†, 58152 †, 58180 †, 58260‡, 58262 ‡, 58263 ‡, 58267 ‡, 58270 ‡, 58275 ‡, 58280 68.3 †, 68.4 †, 68.6 †, 68.39 †, 68.49 †, 68.69 †, 68.5 ‡, 68.7 ‡, 68.79 ‡, 68.39, ‡, 58285 ‡, 58290 ‡, 58291 ‡, 58292 ‡, 58293 ‡, 58294 ‡,58541-58544§, 58550-58554§ 68.49, 68.59, 68.69, 68.79, 68.8, 68.9, 68.31§, 68.41§, 68.51§, 68.61§, 68.71 § *Classified as mesh use. Also classified as mesh use if modifier was present (57267: Insertion of mesh or other prosthesis for repair of pelvic floor defect) † Abdominal approach ‡Vaginal approach §Laparoscopic approach

Dallas KB, Rogo-Gupta L, Elliott CS. Urologic injury and fistula after hysterectomy for benign indications. Obstet Gynecol 2019;134. The authors provided this information as a supplement to their article. ©2019 American College of Obstetricians and Gynecologists. Page 1 of 5

Appendix 2. Cancer Exclusions Codes ICD-9 Diagnosis Codes 179 Malignant neoplasm of uterus, part unspecified 180 Cervical canal NOS 180.1 Cancer exocervix 180.8, 180.9, 182.0, 182.1, 182.8, 233.1 Other specified sites of cervix 183, 198.6, 236.2 Ovarian malignancy 183.2 Fallopian tube 182.0, 183.3, 183.4,183.5, 183.8, 183.9, 233.1, 233.2, 236.0, Uterine malignancy V10.42 233.9 Other and unspecified urinary organs 236.1 Placenta malignancy 184, 184.1,184.2, 184.3,184.4,184.8, 184.9, 198.82, 233.3, Vaginal/Vulvar malignancy 233.30, 233.31, 233.32, 233.39, V10.40 188.0-188.9, 198.1, 233.9, 236.7, 236.9, 236.90, 236.99, Bladder cancer 239.4, V10.51, V10.44, V10.50 153.0-154.3,154.8, V10.05, V10.06 Colorectal cancer 159.0,159.8, 159.9, 197.4, 197.5, 197.8, 239.0 Other digestive organ malignancy 158.0,158.8,158.9, 197.6 Retroperitoneal, peritoneal malignancy 199, 199.1 Carcinomatosis, other malignancy 195.3 Other pelvic malignancy V8741 Personal history of antineoplastic chemotherapy V15.3 Personal history of radiation for malignancy

Appendix 3. Codes Used to Identify Primary Diagnosis Associated With Hysterectomy, Diagnosis of Fistula, and Repair of Urologic Injury Urologic Injury Outpatient CPT Inpatient ICD-9 50840 Ileal Ureter 56.71, 56.73, 56.74 Ureteroneocystostomy 50785 Ureteral reimplant 56.75 Transureteroureterostomy 50783, 50700, 50770 Revision of ureter 56.40, 56.41, 56.79, 56.82, Other ureteral repair 57260 Fusion of ureters 56.83, 56.84, 56.85, 56.86, 50760, 50780, 50783, 50785, Ureteroneocystostomy 56.89, 56.7 50947-50949 57.81, 57.82 Repair of cystotomy 50900 Ureteral repair 59.80 Indwelling stent 52332, 50394 Indwelling stent 55.93, 55.02, 55.03 Nephrostomy 50395 Nephrostomy 55.92, 55.12

Fistula Outpatient CPT Inpatient ICD-9 57300,57320, 57330, 51900, 57300,57320, 57330, 57.83, 57.84, 70.72-70.75,70.79 57305,57037,57308, 51920, 51925 Diagnosis 617.4-617.9 Endometriosis 621.3, 621.30-621.33, 626, 626.2, 626.4, 626.6 Bleeding, Excessive menstruation 218.0-218.2, 218.9, 621.2 Fibroid disease/Hypertrophy of uterus

Appendix 4. Ureteral Injury Diagnosis Codes

ICD-9 Diagnosis Codes 867.2, 867.3 Injury of Ureter, without mention of open wound into cavity 593.3 Stricture or Kinking of Ureter 599.89, 599.9 Other specified disorders of urinary tract 593.5 Hydroureter 593.4, 753.2, 753.20 Obstruction of Ureter 591 Hydronephrosis 753.4, 593.89, 593.8, 753.4 Defect of Ureter, other 593.82 Fistula involving ureter 869, 869.0, 869.1 959, 862, 998.9, 66.94, 998.8, Injury/complication NOS E870.0, E878.8, E878.9, E876.8, E876.9,

Appendix 5. Rates of Cystoscopy by Surgical Approach (a) and Type of Injury (b)

a.) Cystoscopy performed Cystoscopy not performed

n=18,013 n=278,117

Timing of injury identification Timing of injury identification Surgical Approach Immediate Delayed Immediate Delayed Abdominal 372 Total n=109,188 328 (10.4%) 17 (0.5%) 1,502 (1.4%) (0.4%) Cystoscopy n=3,168 (2.9%) Vaginal 184 Total n=62,860 235 (3.3%) 38 (0.5%) 467 (0.8%) (0.3%) Cystoscopy n=7,103 (11.3%) Laparoscopic 387 Total n=77,415 208 (5.5%) 19 (0.5%) 667 (0.9%) (0.5%) Cystoscopy n=3,770 (4.9%) Laparoscopic Assisted Vaginal 192 Total n=36,348 145 (4.6%) 16 (0.5%) 254 (0.8%) (0.6%) Cystoscopy n=3,174 (8.7%)

b.) Delayed injury presentation rate Immediate injury presentation rate Cystoscopy No Cystoscopy Cystoscopy No Cystoscopy n=18,013 n=278,117 n=18,013 n=278,117 Ureteral n=18 (0.1%) n=423 (0.2%) n=612 (3.4%) n=1,764 (0.6%) p<0.001 Bladder n=4 (0.02%) n=103 (0.03%) n=416 (2.3%) n=1,535 (0.6%) p<0.001 Fistula n=71 (0.4%) n=683 (0.2%) NA NA