Wiki 58262 & 57265 vs 58263

[smstearns]

What is the correct code for a vaginal hysterectomy with salpingectomy and/or oophorectomy with an A&P repair and enterocele repair? I was told before that we should be using 58262 and 57265. Someone else recently told me they think 58263 covers all of it. They also placed a mid-urethral sling in this case. We used 57288 for that part. Which way is correct? Thanks.

 

[nielynco]

What is the correct code for a vaginal hysterectomy with salpingectomy and/or oophorectomy with an A&P repair and enterocele repair? I was told before that we should be using 58262 and 57265. Someone else recently told me they think 58263 covers all of it. They also placed a mid-urethral sling in this case. We used 57288 for that part. Which way is correct? Thanks.

There are 2 different ways to code this, one that includes a coding edit and one that does not.
Option 1: 58263 (vag hyst plus enterocele), 57260-59 (A&P repair), 57288-51. The -59 is required because of the 58263/57260 bundle. It is bundled because there is a more inclusive code for A&P repair with enterocele repair, but that does not mean you cannot choose this option as you can override the bundle in this case appropriately.

Option 2: 58262 (vag hyst), 57265-51 (enterocele with A&P repair), 57288-51. This option has no coding edits.

If you look at the RVUs attached to these options and assume a 50% reduction on the second and third procedures, option 1 gives you a 1.15 RVU advantage, but you might also get more headaches in getting it paid due to the coding edit.

58263 DOES NOT cover it all.

 

[smstearns]

There are 2 different ways to code this, one that includes a coding edit and one that does not.
Option 1: 58263 (vag hyst plus enterocele), 57260-59 (A&P repair), 57288-51. The -59 is required because of the 58263/57260 bundle. It is bundled because there is a more inclusive code for A&P repair with enterocele repair, but that does not mean you cannot choose this option as you can override the bundle in this case appropriately.

Option 2: 58262 (vag hyst), 57265-51 (enterocele with A&P repair), 57288-51. This option has no coding edits.

If you look at the RVUs attached to these options and assume a 50% reduction on the second and third procedures, option 1 gives you a 1.15 RVU advantage, but you might also get more headaches in getting it paid due to the coding edit.

58263 DOES NOT cover it all.

Thanks for your help with this!