Wiki 57287 vs 57295 with 52 modifier?

[lcathey@smsc.org]

Patient was in previously and had E/M office visit. Patient was scheduled to return for this procedure only. We aren't sure how to code:
CC: Mesh Removal
HPI: I spoke with GYN ONC and she recommended cutting the mesh tip that was protruding as close to the vaginal epithelium as possible. This would be the first thing to try before going back to the OR.
Procedure:
Exposure of implanted vaginal mesh through vaginal wall. 1 cm of mesh protruding anterior vagina just under pubic ramus. Lidocaine gel applied to the area. The mesh was grasped with forceps and cut with scissors as close to the base to the vaginal epithelium as possible, after first excision, was trimmed again. Minimal bleeding, premarin cream applied.

Any assistance would be greatly appreciated!!! Thank you!

 

[bonzaibex]

The procedure described in the 57287 & 57295 codes are typically done in a facility setting, not in an office setting. Both codes are also listed under the "repair" heading, and this doesn't sound like a vaginal repair procedure. This sounds closer to a foreign body removal kind of thing, and unless it was done under anesthesia (other than local), CPT instructs you to use the appropriate E/M code. Based on the note above, I'd either bill out an E/M code or an unlisted procedure code, 58999.

But that's just me.

Becky