# Revision surgery, CPT help plz



## Karen A. (Feb 5, 2011)

10/14/10 our surgeon did TVH, anterior colporrhapy with mesh, posterior colporrhapy, sacrospinious ligament fixation and perineorrhapy. This surgery was billed as: 58260, 57260-51, 58282-51, 57267-51, 57267, 52000 and was fully paid by medicare

1/17/11 (3 days outside the global period) a return to the operating room occurred. This was due to cystocele & post hysterectomy vaginal vault prolapse. Our patient admitted to lifing heavy objects against her post op instructions and feeling popping sensations. Upon exam in the OR, the patient was found to have enterocele, paravaginal defect and failure of the anterior mesh on the left side. 

2nd surgery was: Posterior colporrhapy with mesh placement in sacrospinious ligament fixation & revision of anterior mesh placement with closure of paravaginal defect. 

I'm new at this and am struggling to accurately report this 2nd surgery in a way my surgeon will be compensated. I have not found any codes to report this specific surgery. What are your thoughts on:

  57285-76 (paravaginal defect repair which includes cystocele repair) and not specifically coding for the mesh revision-or using an ulisted code for the mesh revision?. ICD-9s for post hysterectomy vaginal vault prolapse, cystocele, eneterocele and possibly 996.39-mechanical failure of genitourinary device? 

  57250-76-51 (rectocele repair) 
  57267 (mesh insertion) 

Guidance from experienced coders will be greatly appreciated! I have been learning so much from this list.


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## tmerickson (Feb 7, 2011)

Hi Karen, 

Bad patient! 
You are correct about the coding: 57285-76, 57250-76-51, 57267 however use the following dx codes. Use V15.81 (pt noncompliance) as your primary, and then 618.5, 618.02, 618.04.
Good luck!


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## Karen A. (Feb 8, 2011)

*thankyou!*

thankyou for your thoughtful & informative response. It is greatly appreciated and I will follow your advice!


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