Wiki Vaginectomy- bill it or include in -22?

[Kelly_Mayumi]

So, my surgeon is preforming a radical cystectomy with bilateral pelvic lymph nodes with an ileal conduit, a hysterectomy with bilateral tubes/ovaries (and cervix), a partial vaginectomy, common iliac and presacral lymph node dissection and a urethrectomy all for bladder cancer. I'm definately going to report 51595 and 58180 and I was going to append -22 to 51595 for the urethrectomy and extensive lymphadenectomy. But that partial vaginectomy is getting me. On one hand, the surgeon is already in the area, but on the other hand, it doesn't bundle to the other codes I'm going to report. Any thoughts?

 

[preserene]

YOUR OP NOTE SAYS THAT IT WAS" HYSTERCTOMY".
Point 1) it is most unlikely to go for "Supracervical" (leaving the cervix) and then going for a removal of a cuff of vagina (partial vaginectomy) along with hysterectomy for a cancer case (be it the same organ or adjacent organ). When there is a necessity for removal of uterus and partial vaginectomy, then there would have been a necessity for cervical removal (which is in between the two) too.
Point2) if not mentioned otherwise as Supra cervical/ radical, Hysterectomy goes for total Hysterctomy.
There had been removal of pelvic lymph nodes and the paraaortic lymph node removal there.

So as to me from the whole scenario, it goes more in favor of 58200.
As far as the Gyn procedure, this code 58200 alone suffice to describe the procedure, (apart from the uroprocedures). In that case there is no need for reporting partial vaginectomy separately
However, please clarify with your Surgeon whether it was Supra or radical or total once again, because it really matters for coding accuracy.

 

[Kelly_Mayumi]

The lymph nodes are included in 51595 and the service is more on the uro side vs gyn side. Any thought with this info?

 

[preserene]

No matter the lymph nodes are removed for uroside. It is one patient with the same lymph nodes draining that area(almost similar-pelvic area).The nodes are common for the organs it drain. We needed those nodes removal for the code description.
The hysterectomy code is to be reported separately with the the partial vaginectomy as being a part of the code 58200. I believe this is the most appropriate code for that procedure.