Wiki How to code Removal of pelvic phlebolith??

[amanda.hackett@auihealth.com]

Doctor did a robotic assisted sacrocolpopexy, extensive laparoscopic lysis of adhesions, mid urethral sling retropubic approach, cystourethroscopy, simple cystometrogram and a removal of pelvic phlebolith. There's no code for phlebolith removal. I also think it would be included in the 58660, but since there's no code I can't check for sure. I guess you'd have to bill an unlisted code 49329 and cross reference 49402. Can someone confirm this is correct?

 

[nielynco]

Doctor did a robotic assisted sacrocolpopexy, extensive laparoscopic lysis of adhesions, mid urethral sling retropubic approach, cystourethroscopy, simple cystometrogram and a removal of pelvic phlebolith. There's no code for phlebolith removal. I also think it would be included in the 58660, but since there's no code I can't check for sure. I guess you'd have to bill an unlisted code 49329 and cross reference 49402. Can someone confirm this is correct?

It would not surprise me to find out that the phebolith was an incidental finding during the surgery and the patient was asymptomatic. However, you have not described his procedure in removing it as it could be that he removed a portion of the vein it was attached to or he could have used laser to sclerotherapy to shrink the area and that should determine if there is a code you can use. I would not compare the work to 49402 as the previous descriptions of work I have seen do not show substantive work in their removal (this code as at least 25 RVUs). Check the description and then see if 49329 is really the best laparoscopic code for the work done, or add a modifier -22 to 57425. I hope you know that 58660 is permanently bundled into 57425.