Ob-Gyn Coding Alert

" Urogynecological procedures are performed often in response to complications following total hysterectomies and other gynecological surgeries. Consider the following when billing for these procedures:

  One surgery can have two or more names. For example, a vaginal vault suspension can be a uterosacral ligament vaginal vault suspension, a sacrospinous ligament suspension, or an abdominal sacral colpopexy. CPT has several codes for this type of procedure.

  There are a number of surgical approaches to the same procedure. Harry Stuber, MD, a gynecologist based in Cookeville, Tenn., elaborates: Basically" every urogynecological procedure is done through one or more of three possible routes: abdominal (open) vaginal or laparoscopic."

  CPT cannot keep up with rapidly changing surgical techniques. " CPT codes fall short of meeting the needs of innovative surgeons who are developing new approaches practically every day " Stuber notes.

  CPT advises against picking a code that merely approximates the procedure. "In the current atmosphere of false-claims awareness be sure to select the correct code and not just something similar " says Jan Rasmussen CPC president of Professional Coding Solutions a medical coding and compliance company in Eau Claire Wis. Rasmussen points to new language in the introduction of CPT 2002 that reads "Do not select a CPT code that merely approximates the service provided. If no such procedure or service exists then report the service using the appropriate unlisted procedure or service code."
Despite the many ins and outs of coding for urogynecological procedures CPT 2002 provides the tools necessary to bill ethically and accurately for these complicated and costly surgeries.
Vaginal Vault Suspension
Vaginal vault suspension corrects vaginal prolapse following a hysterectomy (the "vault" being the space that the uterus once occupied) when the top of the vagina breaks away from the uterosacral ligaments that once held it in place. If the uterosacral ligaments are not reattached to the vagina during the initial hysterectomy or if they become unattached prolapse can occur.
 
Note: Cystocele and rectocele refer to anterior and posterior vaginal prolapse respectively and can occur prior to a hysterectomy.
 
The anchor's location determines coding for the vaginal vault suspension. If the physician uses an abdominal approach and attaches the vault of the vagina to the sacrum the procedure is called a colpopexy (57280 Colpopexy abdominal approach). Another type of vaginal vault suspension uses a transvaginal approach. An incision is made in the apex or top of the posterior of the vaginal wall and the prolapsed vaginal vault is then sewn to the internal ligament between the sacrum and the right or left pelvic bone. This is coded as 57282 (Sacrospinous ligament fixation for prolapse of vagina). The third type of vaginal vault suspension is a laparoscopic uterosacral ligament [...]