Urology Coding Alert

Tip: If your physician uses a sling, you only have 1 code to represent the procedure Editor's note: This is the first article in a series on urogynecological procedures. See the next issue of Urology Coding Alert for an article on prolapse surgeries. Female urinary incontinence is a common condition that urologists and urogynecologists surgically treat, and your key to sorting through the various coding options for these procedures is to decipher the surgical approach your physician took.

From both a clinical and coding perspective, it helps to think of incontinence procedures in categories, says Nina Mutone, MD, medical director of the urogynecology division at St. Vincent's Hospital in Indianapolis. Your physician can choose from the following surgical options for incontinence:

• retropubic suspension
• needle procedures
• slings. Choose CPT 51840 , 51841 for Retropubic Urethropexy Your urologist may choose a retropubic suspension to treat a female patient with urinary incontinence. If the op report states that the sole surgical approach was abdominal and the physician performed either a Marshall-Marchetti-Krantz (MMK) or Burch procedure, you can immediately narrow your search to two codes: 51840 (Anterior vesicourethropexy, or urethropexy [e.g., Marshall-Marchetti-Krantz, Burch]; simple) and 51841 (... complicated [e.g., secondary repair]).

During an MMK procedure, the surgeon places sutures into the vaginal wall at the level of the urethra or bladder neck and anchors them to the pubic bone. For a Burch sling procedure, the surgeon would anchor the sutures to the Cooper's ligament.

Your physician's documentation is the key to choosing 51840 or 51841. You can consider a retropubic suspension procedure to be complicated in the following situations:

• If it is a secondary repair following a previous surgery.
• If there is extensive bleeding during surgery.
• If the patient has adhesions from a previous surgery.
• If the patient has vaginal prolapse.
• If the procedure takes an excessive amount of time to complete.
• If the patient is obese.
• If the surgeon encounters aberrant anatomy. Tip: A good way to double-check your code selection is to determine whether the patient's diagnosis correlates to procedures 51840 and 51841. Possible diagnoses for MMK and Burch procedures include stress incontinence (625.6), vaginal prolapse (618.x), and mixed incontinence (788.33). See the chart later in this issue for more information.
Understanding the Problem Urinary incontinence is identified as one of four common types: stress (625.6), urge (788.31), mixed stress and urge (788.33), or unspecified (788.30). These conditions in females, especially stress incontinence, may be associated with pelvic organ prolapse (618.x); pelvic floor defects as a result of previous gynecological surgery; vaginal births; underlying neurologic, gastrointestinal, or pulmonary disease; smoking; obesity; and occupational and recreational factors. In many cases, these conditions are treated with surgery.
Don't Let 51845 Needle You Another [...]