# need help coding multiple procedures



## snjberry (Mar 3, 2011)

Need Help coding 
supracervical hysterectemy (58180) / abdominal sacral colpopexy (57280) with pelvitex anvantage tension free suburethral sling  (57288), posterior repair with repilform graft (?)

not sure if there are better codes to bundle this into one or two procedures
or correct modifiers with this procedure.

sberry


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## OCD_coder (Mar 3, 2011)

I am wondering if the 57284 is more descriptive of the work.  I am not locating a separate graft code to report, but the work the surgeon did is more than a simple colpopexy.

Would love to hear other thoughts on this.


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## snjberry (Mar 3, 2011)

would you code supracervical hysterectomy 58180 with 57284 with 59 modifier
sberry


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## preserene (Mar 3, 2011)

Supracervical hysterectomy-58180 to be reported as the main procedure.

Colpopexy can share as a combined code.
 This my openion.
57288 open procedure can reported for sling/TVT procedure.

As per AMA
Sling/TVT tape procedures-
Use the 57288 code if the procedure is performed as an open procedure. According to the AMA's CPT Assistant newsletter, CPT code 57288 describes the placement of fascia or other materials at the urethrovesical junction to encircle and suspend the urethra for treatment of stress incontinence. The ends of the sling are pulled toward the symphysis pubis and fastened to the rectus abdominus sheath.* This procedure is for a combined anterior vaginal and abdominal approach. *
If tape is used in the procedure, don’t forget to bill for the TVT tape — the C1771 HCPCS code can be used to bill for the sling supply to some payors, if the payor reimburses for implants. However, don’t use C-codes to bill implants to Medicare. Other possible codes to use instead (depending upon the payor) include L8699 or 99070.

But in our case, the posterior repair has to be addressed to if done  and documented.
the code 57250 is not combined in any of the above procedures.
(if no mention of repair of rectocele, 57250 would go with)

So to consolidate  I think 58180, 57288, 57250-51 and HCPCS code if tape used would do.
I still would like some experts openion to confirm .


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## preserene (Mar 3, 2011)

If there had been  associated cystocele and cystocele repair done along with , I feel we could think of paravaginal defect repair.

It would be better and help us if we had been provided with the whole OP notes and diagnoses documented by the physician, because there are very minor intricacies and details which could change the code assignment.


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## fami (Mar 4, 2011)

You can bill these 3 codes togethere.

CPT/CCI Results
Code Description 
58180 PARTIAL HYSTERECTOMY 

57280 SUSPENSION OF VAGINA 

57288 REPAIR BLADDER DEFECT 


(Column 1) Component Codes
(Column 2) CCI Modifier 

Mutually exclusive codes Comprehensive Codes
(Column 1) Component Codes
(Column 2) CCI Modifier 

Make sure you bill for sling C code.
Fami


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## preserene (Mar 4, 2011)

Fami, 
I do not understand the concept of bundling the subtotal hysterectomy  along with the other two.
So could you please give the final assignment of code sets for this scenario?
And could you kindly give the reference sites for the Mutually exclusive codes Comprehensive Codes, (Column 1) Component Codes, (Column 2) CCI Modifier ?


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