Urology Coding Alert

Question: The urogynecologist on our team carried out an Altis sling procedure to treat urinary stress incontinence, and also performed a posterior colporrhaphy using native tissue to address vaginal prolapse and rectocele. Should I bill: 57267 for the native tissue or is there a more specific code, such as 57288 or 57250?

Nevada Subscriber

Answer: CPT^® code 57288 (Sling operation for stress incontinence (eg, fascia or synthetic) is correct for the Altis sling insertion. Code 57250 (Posterior colporrhaphy, repair of rectocele with or without perineorrhaphy) is also appropriate with proper documentation from the practitioner.

CPT^® +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)) would not be appropriate for this claim. “Native tissue is not considered prosthetic graft/ mesh, which is the purpose of that code. If native tissue from the patient is harvested, the area harvested would determine the correct CPT^® code,” says Stephanie Storck, CPC, CPMA, CUC, CCS-P, ACS-UR, longtime urology coding expert and consultant in Glen Burnie, Maryland.

According to Storck, “because 57288 has the highest relative value unit [RVU], it should be listed first, and any subsequent procedures would be reported with modifier 51 [Multiple procedures]. Next, 57250 would be reported with the 51 modifier and if any harvesting of tissue can be reported, then that code would be reported with the 51 modifier as well.”

Look closer: “For example, if the tissue was harvested from the deep tissue of the thigh with a stripper, then 20920 [Fascia lata graft; by stripper] can be used. If the fascia lata graft from the thigh was harvested by incision and area exposure, then 20922 [Fascia lata graft; by incision and area exposure, complex or sheet] is appropriate. Sometimes surgeons might harvest tissue from the mouth as well. These are known as buccal grafts identified by 40818 [Excision of mucosa of vestibule of mouth as donor graft],” says Storck.

Bottom line: You will need to read the op note carefully or query the provider to find out where and how the tissue was harvested for the graft.