Wiki 57288 and 51845


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I have a Urologist that is stating he wants to code CPT 57288 and 51845 together. I keep getting denials from different payers stating these two codes are inclusive of each other. There is no CCI edit and the only thing I can find on the net states that it is unusual to code these two together but not impossible.

Answer: CPT 57288 (sling operation for stress incontinence [e.g., fascia or synthetic]), 51845 (abdomino-vaginal vesical neck suspension, with or without endoscopic control [e.g., Stamey, Raz, modified Pereyra]) and 57240 (anterior colporrhaphy, repair of cystocele with or without repair of urethrocele) are not bundled, according to version 7.0 of the Correct Coding Initiative (CCI). Theoretically, they could be billed together, as 57288, 51845-51 (multiple procedures) and 57240 -51. Private carriers may nevertheless view these as separate but integral procedures and limit payment for all three together. Surgically, it would be unusual to do a Raz/Stamey procedure at the same time as a sling procedure, although on occasion they could be combined.

Can anyone offer suggestions please? :eek:

Thank you!

Many payers have custom edits in addition to NCCI. If its truly separately reportable use modifier 59 on the second code and if that doesn't work appeal would be necessary as records would need to be revewed