Ob-Gyn Coding Alert

And you should code it that way

Insurance carriers may argue that genital prolapse repair is included in other procedures, but don't give up. As long as you can prove medical necessity, you can get paid.
 
Ob-gyns frequently use vaginal vault suspension to correct vaginal prolapse following a hysterectomy when the top of the vagina breaks away from the uterosacral ligaments that once held it in place. If the physician does not reattach the uterosacral ligaments to the vagina during the initial hysterectomy, prolapse can occur. You Have 3 Choices for Prolapse Treatment Alone  
Where the surgeon anchors the uterosacral ligaments determines which code you should use for the vaginal vault suspension. If the ob-gyn uses an abdominal approach and attaches the vaginal vault to the sacrum using mesh, you should report a colpopexy with 57280 (Colpopexy, abdominal approach), says Donna C. Kroening, CPC, reimbursement manager for the ob-gyn department at the Medical College of Wisconsin in Milwaukee.
 
On the other hand, if the physician uses a transvaginal approach, you should report 57282 (Sacrospinous ligament fixation for prolapse of vagina). During this procedure, the surgeon makes an incision in the top of the vaginal wall's posterior and sews the prolapsed vaginal wall to the sacrospinous ligament between the sacrum and the right or left pelvic bone, Kroening explains.
 
A third type of vaginal vault suspension incorporates a laparoscopic approach. Called a laparoscopic uterosacral ligament suspension, the ob-gyn attaches the uterosacral ligament to the top of the vagina. This is different from the traditional colpopexy because the surgeon performs it laparoscopically. Fortunately, CPT 2004 includes a new code for this procedure, says Brenda Dombkowski, CPC, a coding specialist at Obstetric-Gynecology & Infertility Group in Cheshire, Conn. You should report the laparoscopic vaginal vault suspension as 57425 (Laparoscopy, surgical, colpopexy [suspension of vaginal apex]) after Jan. 1, 2004, she adds.
 
"Our practice does not do it laparoscopically because it's not proven to be very effective," Kroening says. Her ob-gyns feel that the procedure is more effective when performed vaginally (57282). Hysterectomy Causes Coding Complications Ob-gyns often run into problems when billing a vaginal vault suspension at the same time as a hysterectomy. Although the American College of Obstetricians and Gynecologists (ACOG) states that in the case of total or subtotal abdominal hysterectomies "repairs or suspension procedure of vagina, urethra and perineum" are "examples of intraoperative services excluded from the global service," many carriers deny the suspension for lack of medical necessity. They argue that the suspension procedure is preventive rather than restorative at the time of the hysterectomy because the physician performs it to prevent [...]