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57282 bundled to 58294

  1. Question 57282 bundled to 58294
    Medical Coding Books
    Good morning all,

    Does anyone know if 57282 is bundled to 58294?

    Thanks for all of your help...

  2. #2
    Default
    You may want to checkwith your local payors suplemental edits, but 57282 does not appear to bundle to 58294 in the NCCI edits...

  3. Default
    I think the NCCI does not come into the picture with 57282.
    For intraperitoneal approach you would have to report even if it was documented with posterior COLPORRHAPHY PROCEDURE. (ie) YOU WOULD REPORT: 58294, 57250, and 57282 with mod 51 and 59 as it requires.

    For extraperitoneal approach, if POSTERIOR COLPORRAPHY WAS DOCUMENTED, then the 57282 becomes a part and parcel of the colporrhaphy procedure, an dneed not be reported separately.

    I feel it would have been nice if provided with more info to give an openion for such a complex and controversial subject of these different procedures of Pelvic Prolapse Repair, meaning, we need to know, what are the procedures in the operation notes- like posterior colporraphy done or not. usually and always this is done in posterior vaginal defect/rectocele. BUT we need documentation.

    Well, if posterior colporrhaphy done, then 57282 procedure becomes a part and parcel of the colporraphy and need not be reported separately. But the procedure 57283 'intraperitoneal approach' which needs lots of work and is combersome with more intricacy, can be reported separately.Yet some payers accept all three codes hysterctomy code, colporraphy code and colpopexy even with extra peritoneal approach.

    If colporrhaphy is not documented and not going to be reported separately, then 57282 should be reported separately as a second in the sequencial proceduralcode (ie after the Hysterectomy code for better revenue.
    Also you would append Mod-51, 59 to 57282.

    PS: All these need pertinent documentation of OP notes, and supported by the appropriate diagnosis ICD -9 codes.
    Hope this is help.
    Thank you for your time

  4. Question I hope this isn't too much...
    ?????
    Last edited by coders_rock!; 06-20-2011 at 02:41 PM.

  5. Default
    THank you.

    I infer that the surgeries done are Vaginal Hysterectomy, Sling operation, Enterocele Repair, Rectocele repair, cystocele repair, vault suspension or Sacrospinaous Fixation by intraperitoneal approach and Mesh insertion into both anterior and posterior compartments of the vagina.
    The vaginal Hysterectomy (assuming the uterus wt 250grms) and the sling operation for SUI with endoscopic control merits for the code – 58293.
    Anterior and posterior colporrhaphy – combined code- 57260-51
    Vault suspension intraperitonel approach- --------------57283-51
    Mesh insertion for each anterior and posterior compartments- + 57267 X 2
    Enterocele is billed or bundled onto the colporrhaphy procedures. So cannot be reported separately.
    So the sequencing would be : 58293, 57260-51, 57283-51, 57267 X 2.

    [ Many payers look for codes for existing
    fascial weakness and why mesh is required to establish medical
    necessity.To avoid denials, link mesh add-on code 57267
    to 618.81 (Incompetence or weakening of pubocervical tissue;
    anterior compartment) or 618.82 (Incompetence or weakening
    of rectovaginal tissue; posterior compartment).
    Code 57267
    specifically addresses only the anterior and posterior compartments;
    only codes 618.81 and 618.82 establish medical
    necessity.

    For colpopexy, ICD9 code 618.5 (Prolapse of vaginal vault after
    hysterectomy) links to a colpopexy code for vaginal vault
    for prolapse after hysterectomy.

    For stress incontinence 625.6 as primary diagnosis, In fact, ICD9 guidelines allow only the diagnosis code 625.6 or other incontinence symptom codes (788.30-788.39) to be reported as a secondary diagnosis when a more definitive diagnosis has
    been reported.

    For Vaginal colpopexy, even though done on both sides, will not use modifier-50. Vaginal colpopexy, permanent
    sutures are placed through these pelvic ligaments…” The code revision
    and valuation under RBRVS assumes this procedure to be bilateral.
    Therefore, no modifier -50 may be reported. Medicare
    will not accept a modifier -50.]

    As regards ICCI edits, CPT regulations and ACOG coding manual clips:

    The National Correct Coding Initiative
    (NCCI) does not bundle the colporrhaphy codes with either
    sling procedures for SUI or vaginal vault suspension; per
    the ACOG Procedural Coding Manual, colporrhaphy codes
    are reported in addition. The Ingenix OB/GYN Coding Companion,
    however, is a guide; some payers may bundle colporrhaphy
    codes when a vaginal vault suspension is performed.
    This information may relate to the clinical vignette submitted
    in 2005 to the CPT Editorial Panel for revision to code 57282,
    describing presence of cystocele, rectocele, and enterocele
    with a suspension of the vaginal apex and repair of the cystocele,
    rectocele, and enterocele.
    The National Correct Coding Initiative(NCCI) does not bundle the
    colporrhaphy codes with eithersling procedures for SUI or vaginal
    vault suspension; per the ACOG Procedural Coding Manual, colporrhaphy codes
    are reported in addition. The Ingenix OB/GYN Coding Companion,
    however, is a guide; some payers may bundle colporrhaphy
    codes when a vaginal vault suspension is performed.
    This information may relate to the clinical vignette submitted
    in 2005 to the CPT Editorial Panel for revision to code 57282,
    describing presence of cystocele, rectocele, and enterocele
    with a suspension of the vaginal apex and repair of the cystocele,
    rectocele, and enterocele.
    Since the colporrhaphy codes are not bundled under NCCI rules and CPT
    does not prohibitthis code combination, it is advised reporting all procedures
    performed,unless the payer specifically includes them. But pertinent and appropriate
    documentations are the main stay of acceptance by most of the payers ].

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