I understood that it was not an open procedure. I indicated an LAVH with salpingo-oopherectomy as per the description of codes 58267 and 58293 I didn't see indication of additional value being allowed for the removal of those structures. With the codes I suggested, the colporrhaphy and sling are not included. Additionally 58267 and 58293 don't indicate the use of a sling as mentioned in the original post, it indicates the Marshal-Marchetti-Krantz type or Pereyra type which utilize sutures to suspend or elevate the bladder. The code I suggested 58992, specifically indicates a lap sling operation for stress incontinence (not open, which would be 57288).
I would disagree that a posterior colporrhaphy is an integral part of a RAVH (58552) simply because I have seen hundreds of case in which a colporrhaphy was never completed during the course of a LA or RAVH because it was not needed. Bear in mind that I chose the secondary and tertiary codes based on my primary, not yours. It may be integral to the CPTs you listed, I have not checked. Based on the DX (pelvic relaxation with urinary stress incontinence) listed it indicates to me that the colporrhaphy was related to the repair of a rectocele, which is why I chose 57250. I also chose this code as the listed procedure indicates a posterior colporrhaphy, which is exactly what 57250 is. This has no relation to the laparoscopic procedure what so ever as it's an entirely different approach.
I maintain, based on your observation, my choices. Does this make good code sense? To assume that a very detailed, integrated and time consuming procedure is "bundled" in one code that only indicates 1 1/2 (as 58267 and 58293 offer a different technique for the sling retropubic urethropexy) of the 5 separately listed codes? Or to select more descriptive codes, that are not inclusive to each other, which in total will account for all services rendered and obtain appropriate payment with proper modifications?
In reference to utilization of combined surgical codes, they are appropriate when the procedures combined in that code are the ones completed. Additionally 58552 and 58554 are codes that indicate multiple procedures, just not the same two in 58267 and 58293.
Amy Lynne~I would look up all the codes provided 58267, 58293, 58552, 58554, 51992 and 57250 and use them as a point of reference in reviewing your op report. Often times I find what has been dictated isn't what is actually listed at the beginning of my reports under procedures. Either one of us could be right, or we could both be wrong. I'd also like to suggest looking into an OB/GYN specific coding companion if you're just getting back into the swing of things, it can be very useful. Good luck!