Urology Coding Alert

Test your coding knowledge.  Determine how you would code this situation before looking at the box below for the answer.
Question: How should we code for a fat pad repair for a urethrovaginal fistula? What about a fat pad repair for a vesicovaginal fistula?

Texas Subscriber

    Answer: Use CPT 57311 (closure of urethrovaginal fistula; with bulbocavernosus transplant) for closure of a urethrovaginal fistula. If you perform only the fat pad repair, append modifier -52 (reduced services) to 57311. There is no code for the pad. Send in the notes with the claim and explain that you only used the fat pad.
 
For repair of a vesicovaginal fistula with a Martius fat pad, use CPT 57320 (closure of vesicovaginal fistula; vaginal approach) and 57311-52-51 (multiple procedures) with the second code indicating the use of the Martius fat pad in addition to the vesicovaginal fistula repair. These codes are not bundled. However, you must file a claim on paper with documentation and the operative report.
 
When performing surgery on the urethra, urologists may use the Martius fat pad to promote healing. The fat pad is adjacent to the surgical site in the labial folds. When dissected out as a pedicle flap, it can be moved to a different place, maintaining its original blood supply. Code 57311 includes the harvesting. Do not bill 20926 (tissue grafts, other [e.g., paratenon, fat, dermis]) for this procedure.