Wiki pelvic prolapse dx codes

[KMO1963]

Need clarification on correct way to assign icd-10 codes for prolapse: should I assign N81.3 to both 58571 and 57260 or should I use N81.11 and N81.6 with 57260? Can you code N81.3 on one cpt code and N81.11/N81.6 on a different cpt code during same case (since guidelines say not to report those together)?

pre and post op diagnoses:
postmenopausal bleeding
complete uterovaginal prolapse
midline cystocele
rectocele
stress urinary incontinence

procedures performed:
robot assisted total lap hysterectomy (uterus under 250 grams) with bilateral salpingo-oophorectomy
anterior repair of cystocele
posterior repair of rectocele
TOT sling for SUI

TIA

 

[nielynco]

Need clarification on correct way to assign icd-10 codes for prolapse: should I assign N81.3 to both 58571 and 57260 or should I use N81.11 and N81.6 with 57260? Can you code N81.3 on one cpt code and N81.11/N81.6 on a different cpt code during same case (since guidelines say not to report those together)?

pre and post op diagnoses:
postmenopausal bleeding
complete uterovaginal prolapse
midline cystocele
rectocele
stress urinary incontinence

procedures performed:
robot assisted total lap hysterectomy (uterus under 250 grams) with bilateral salpingo-oophorectomy
anterior repair of cystocele
posterior repair of rectocele
TOT sling for SUI

TIA

Per ICD10 instructions and guidelines categories, N81.3 is an all inclusive code which includes both a rectocele and cystocele in addition to vaginal prolapse. Therefore you would not code separately for each condition under these rules as this is the most specific code. You would, however code N39.3 in support of the sling procedure as this was done specifically for SUI. The code N81.3 (complete uterovaginal prolapse) would support billing for all the procedures you have listed except the TOT sling.

 

[KMO1963]

Per ICD10 instructions and guidelines categories, N81.3 is an all inclusive code which includes both a rectocele and cystocele in addition to vaginal prolapse. Therefore you would not code separately for each condition under these rules as this is the most specific code. You would, however code N39.3 in support of the sling procedure as this was done specifically for SUI. The code N81.3 (complete uterovaginal prolapse) would support billing for all the procedures you have listed except the TOT sling.

Ok thank goodness! That's how I've been coding, but the surgicenter was telling my provider to use the cystocele and rectocele code on 57260 so I started doubting myself . I really appreciate your expertise, thanks so much!

 

[TanBro]

Per ICD10 instructions and guidelines categories, N81.3 is an all inclusive code which includes both a rectocele and cystocele in addition to vaginal prolapse. Therefore you would not code separately for each condition under these rules as this is the most specific code. You would, however code N39.3 in support of the sling procedure as this was done specifically for SUI. The code N81.3 (complete uterovaginal prolapse) would support billing for all the procedures you have listed except the TOT sling.

Would this be the same with incomplete? N81.2? My doc did a LAVH with anterior and posterior repair. I'm doing 58554 (uterus weight 350 with removal of tubes) and 57260. So my question is can I use N81.2 on both CPT codes on the same claim or should I do N81.11 and N81.6 on 57260 since it was incomplete?

 

[nielynco]

Would this be the same with incomplete? N81.2? My doc did a LAVH with anterior and posterior repair. I'm doing 58554 (uterus weight 350 with removal of tubes) and 57260. So my question is can I use N81.2 on both CPT codes on the same claim or should I do N81.11 and N81.6 on 57260 since it was incomplete?

Both N81.11 and N81.6 have an excludes 1 note that indicates you could not also report N81.2-N81.4. This means that when either or both a cystocele and rectocele are present with uterine prolapse you always report the more specific code, N81.2, N81.3 or N81.4. In this case, the uterus was removed due to uterine prolapse with included both a cystocele and rectocele so N81.2 covers the medical necessity of all procedures performed.

 

[TanBro]

Both N81.11 and N81.6 have an excludes 1 note that indicates you could not also report N81.2-N81.4. This means that when either or both a cystocele and rectocele are present with uterine prolapse you always report the more specific code, N81.2, N81.3 or N81.4. In this case, the uterus was removed due to uterine prolapse with included both a cystocele and rectocele so N81.2 covers the medical necessity of all procedures performed.

Thankyou so much!!