Ob-Gyn Coding Alert

You can report mesh with some prolapse procedures -- learn which ones If you-re concerned about when to report vaginal prolapse codes alone and when to report them together, help is here.
 
Our experts say that the keys to reporting prolapse codes properly are two things: the exact type of the prolapse and the ob-gyn's surgical approach. Code Mesh With Colporrhaphy, Not Defect Repair A patient may present to your office with a prolapse of the anterior vaginal wall, which is commonly called a cystocele (618.01, Prolapse of vaginal walls without mention of uterine prolapse; cystocele, midline; or 618.02, Prolapse of vaginal walls without mention of uterine prolapse; cystocele, lateral). Your physician will perform either an anterior colporrhaphy or a paravaginal defect repair, so you-ll have to choose between two procedure codes.
 
For an anterior colporrhaphy, use 57240 (Anterior colporrhaphy, repair of cystocele with or without repair of urethrocele). If the ob-gyn also repairs a urethrocele (618.03), you should not separately report its repair because it is included in the code description of 57240.
 
Bonus: During some anterior colporrhaphy procedures, the surgeon will add mesh to strengthen the repair, says Melanie Witt, RN, CPC-OGS, MA, an independent coding consultant in Guadalupita, N.M. You should report the mesh insertion using +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]). This add-on code requires no modifier or fee reduction and has an unadjusted 2006 Medicare allowable of $284.23.
 
When the surgeon performs a paravaginal defect repair via an open or vaginal approach, report 57284 (Paravaginal defect repair [including repair of cystocele, stress urinary incontinence, and/or incomplete vaginal prolapse]). For a laparoscopic approach, use 49329 (Unlisted laparoscopy procedure, abdomen, peritoneum and omentum), Witt says.
 
Beware: The National Correct Coding Initiative bundles the Burch procedure, slings, anterior colporrhaphy and enterocele repair with the paravaginal defect repair, so you cannot report them separately. You also can't report 57267 for a mesh insertion with 57284 or 49329 even though it is not an NCCI bundle, Witt says. -This is because CPT specifically cites the codes that can be billed with an add-on mesh, and CMS does not normally create bundles for code combinations that are clearly spelled out in CPT,- she adds.
 
Tip: When your ob-gyn adds a mesh to a paravaginal defect repair, append modifier 22 (Unusual procedural services) to 57284 to indicate the extra work involved. Submit a detailed op report as well as a concise explanatory note of the procedure in layman's terms. You Have 4 Choices for Vaginal Prolapse Treatment If a patient has a prolapse of either the uterus or the vaginal vault, your physician [...]