Ob-Gyn Coding Alert

Learn the history behind colpopexy codes Heard about the new code for the Essure sterilization procedure and want to know more? Get the scoop on this and other important CPT 2005 additions and revisions - ranging from mesh insertion to colpopexy to cryoablation - and know how to use them starting Jan. 1. 1. Report Mesh Insertion Code as an Add-On When you scan your CPT 2005 book for a mesh insertion code, you'll spot new add-on code +57267 (Insertion of mesh or other prosthesis for repair of pelvic floor defect, each site [anterior, posterior compartment], vaginal approach [list separately in addition to code for primary procedure]).  
 
Remember: This procedure is an "add-on" code, which means "you should never bill it alone; you must report it with another primary code," says Jan Rasmussen, CPC, AGS-GI, ACS-OB, president of Professional Coding Solutions in Eau Claire, Wis. Also, keep in mind that add-on codes do not take a modifier.
 
You can report 57267 with 45560 (rectocele repair), 57240 (anterior colporrhaphy), 57250 (posterior colporrhaphy), 57260 (combined anteroposterior repair), or 57265 (combined anteroposterior repair with enterocele repair). 2. Inserting Mesh Also Means a Colpopexy CPT has added two new codes to reflect techniques for performing colpopexy or vaginal vault suspension. "You would never put in mesh without also doing a colpopexy," says Harry Stuber, MD, FACOG, an independent gynecologist in Cookeville, Tenn.
 
The history: The code for an abdominal colpopexy (57280) was added to CPT prior to 1992, and a new code for laparoscopic colpopexy (57425) was added in 2004. However, up until this year, the only code for a vaginal colpopexy describes suspending the vaginal apex to the sacrospinous ligament. But there are other ways of suspending the vaginal vault. Therefore, the American College of Obstetrics and Gynecology (ACOG) requested a revision to 57282 and a new code to reflect this (deleted content is in bold):

  57282 - Sacrospinous ligament fixation for prolapse of vagina Colpopexy, vaginal; extra-peritoneal approach (sacrospinous, iliococcygeus)

  57283 - ... intra-peritoneal approach (uterosacral, levator myorrhaphy). When you're looking at your ob-gyn's op note and trying to decide which code to use, you can break down your choice by whether the suspension takes place outside of the peritoneal cavity by attaching it to the iliococcygeus muscle or sacrospinous ligament, or inside the peritoneum using the uterosacral ligament or performing a high midline levator myorrhaphy. 
 
"[Previous to this addition], many surgeons used the uterosacral ligaments or the ileococcygeus muscle and had to resort to reporting either an unlisted-procedure code or the sacrospinous ligament code, which wasn't quite accurate," Stuber says. Now [...]