THank you.
I infer that the surgeries done are Vaginal Hysterectomy, Sling operation, Enterocele Repair, Rectocele repair, cystocele repair, vault suspension or Sacrospinaous Fixation by intraperitoneal approach and Mesh insertion into both anterior and posterior compartments of the vagina.
The vaginal Hysterectomy (assuming the uterus wt 250grms) and the sling operation for SUI with endoscopic control merits for the code – 58293.
Anterior and posterior colporrhaphy – combined code- 57260-51
Vault suspension intraperitonel approach- --------------57283-51
Mesh insertion for each anterior and posterior compartments- + 57267 X 2
Enterocele is billed or bundled onto the colporrhaphy procedures. So cannot be reported separately.
So the sequencing would be : 58293, 57260-51, 57283-51, 57267 X 2.
[ Many payers look for codes for existing
fascial weakness and why mesh is required to establish medical
necessity.
To avoid denials, link mesh add-on code 57267
to 618.81 (Incompetence or weakening of pubocervical tissue;
anterior compartment) or 618.82 (Incompetence or weakening
of rectovaginal tissue; posterior compartment). Code 57267
specifically addresses only the anterior and posterior compartments;
only codes 618.81 and 618.82 establish medical
necessity.
For colpopexy, ICD9 code
618.5 (Prolapse of vaginal vault after
hysterectomy) links to a colpopexy code for vaginal vault
for prolapse after hysterectomy.
For stress incontinence
625.6 as primary diagnosis, In fact, ICD9 guidelines allow only the
diagnosis code 625.6 or other incontinence symptom codes (788.30-788.39) to be reported as a secondary diagnosis when a more definitive diagnosis has
been reported.
For Vaginal colpopexy, even though done on both sides,
will not use modifier-50. Vaginal colpopexy, permanent
sutures are placed through these pelvic ligaments…” The code revision
and valuation under RBRVS assumes this procedure to be bilateral.
Therefore, no modifier -50 may be reported. Medicare
will not accept a modifier -50.]
As regards ICCI edits, CPT regulations and ACOG coding manual clips:
The National Correct Coding Initiative
(NCCI) does not bundle the colporrhaphy codes with either
sling procedures for SUI or vaginal vault suspension; per
the ACOG Procedural Coding Manual, colporrhaphy codes
are reported in addition. The Ingenix OB/GYN Coding Companion,
however, is a guide; some payers may bundle colporrhaphy
codes when a vaginal vault suspension is performed.
This information may relate to the clinical vignette submitted
in 2005 to the CPT Editorial Panel for revision to code 57282,
describing presence of cystocele, rectocele, and enterocele
with a suspension of the vaginal apex and repair of the cystocele,
rectocele, and enterocele.
The National Correct Coding Initiative(NCCI) does not bundle the
colporrhaphy codes with eithersling procedures for SUI or vaginal
vault suspension; per the ACOG Procedural Coding Manual, colporrhaphy codes
are reported in addition. The Ingenix OB/GYN Coding Companion,
however, is a guide; some payers may bundle colporrhaphy
codes when a vaginal vault suspension is performed.
This information may relate to the clinical vignette submitted
in 2005 to the CPT Editorial Panel for revision to code 57282,
describing presence of cystocele, rectocele, and enterocele
with a suspension of the vaginal apex and repair of the cystocele,
rectocele, and enterocele.
Since the colporrhaphy codes are not bundled under NCCI rules and CPT
does not prohibitthis code combination, it is advised reporting all procedures
performed,unless the payer specifically includes them. But pertinent and appropriate
documentations are the main stay of acceptance by most of the payers ].