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Ob-Gyn Coding Alert

Dont Stress When Coding Urinary Incontinence Surgical Procedures

Published on Thu Aug 01, 2002

The optimal surgical approach to treatment of stress urinary incontinence (SUI) in women continues to be a topic of controversy, and coders must stay on their toes to keep up with all the treatment options.
 
What Is SUI and What Treatments Are Available?  

SUI (625.6) is urine leakage that occurs during an activity such as laughing, lifting or sneezing that causes pressure (or "stress") on the bladder. "It is often caused by vaginal deliveries, women with severe obesity, pelvic tumors or chronic constipation and can be treated effectively with pelvic floor exercises, devices that block the loss of urine, or surgery," says Patrick J. Culligan, MD, assistant professor of OBG, division of urogynecology and reconstructive pelvic surgery, department of obstetrics, gynecology, and women's health at the University of Louisville in Kentucky.

 "Surgical intervention should only be considered after a complete and thorough evaluation and failure of more conservative methods such as biofeedback (90911) and therapeutic procedures," Culligan says. This evaluation should be well documented in the medical record to ensure payment for the surgical procedure and avoid having to appeal a denial.

When it comes to treating stress incontinence, not all surgical procedures are equal. Fortunately, research studies performed by the American Urological Association have identified two basic kinds of surgical procedures as the best:

 1. The Burch urethral suspension procedure (51840)
 2. The suburethral sling operation (57288)

 And a new type of suburethral sling known as tension-free transvaginal tape (TVT) can be performed on an outpatient basis under local anesthesia. It is a minimally invasive procedure with a very short recovery period and few complications and minimal scarring after surgery. Terry Tropin, RHIA, CPC, CCS-P, manager, coding education for the American College of Obstetricians and Gynecologists (ACOG), says the coding committee at ACOG is recommending the use of 57288 (see full definition below) for the procedure. "The traditional sling and the tape procedure both include vaginal and abdominal incisions," she says.

Note: For a detailed list of other procedures performed for stress incontinence, see article two.

Understand the Procedures for Accurate Coding

The following is a summary of what each procedure involves:
 

  •  Code 51840 Anterior vesicourethropexy, or urethropexy (Marshall-Marchetti-Krantz, Burch); simple. Possible diagnosis is stress incontinence (625.6). The surgical approach is normally abdominal. Sutures are placed into the vaginal wall at the level of the urethra/bladder neck and anchored to the pubic bone (MMK) or Cooper's ligament (Burch). 
     
  •  Code 57288 Sling operation for stress incontinence (e.g., fascia or synthetic). Possible diagnosis is stress incontinence, intrinsic sphincter deficiency (599.82). The surgical approach is vaginal and abdominal. Sutures are placed from a sling under the mid-urethra to rectus abdominus sheath.

    Although TVT is reported with 57288, the surgical procedure is slightly different. The TVT's sling is placed, providing new support to tissue with less morbidity than traditional sling procedures. There is no need to harvest graft material. Therefore, fewer incisions are necessary. One incision is made into the vagina, and a synthetic tape is inserted between the vagina and abdominal wall. In four to six weeks, tissue grows around the tape and holds it in place. This in turn supports the neck of the bladder. The sling is also individualized for each patient during the TVT operation, thus reducing the chance that the patient will need a catheter for any prolonged time after the operation. "Therefore, insurance companies are likely to favor this new procedure for reimbursement purposes," Tropin says.

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