Ob-Gyn Coding Alert

Question: The op note states, “Laparoscopic Uterosacral suspension, A&P repair w/culdoplasty. Mini Arc mid urethral sling and cystourethroscopy & removal of right vulvar lesion.” I am looking at 57425; 51990. Are those codes correct?

New York Subscriber

Answer: You will find no such animal as a laparoscopic A&P repair – by definition of what is being done. The physician is repairing the anterior and posterior vaginal walls, which can only be accomplished from the outside in. He can of course perform a laparoscopic sling procedure or colpopexy at the same surgery. In this case, he performed the following procedures:

• Laparoscopic uterosacral suspension: 57425 (Laparoscopy, surgical, colpopexy [suspension of vaginal apex]).
• A&P repair with culdoplasty: The culdoplasty is a repair of an enterocele and if done at the same time as the A&P repair you would report code 57265 (Combined anteroposterior colporrhaphy; with enterocele repair). Just make sure there was indeed a reported enterocele as sometimes they do the culdoplasty for preventive reasons in which case you could only report 57260 for the A&P repair.
• MiniArc Urethral Sling: This is a small piece of mesh placed under the urethra via a tiny incision – it is also not performed laparoscopically and in fact is a simple sling procedure for stress urinary incontinence so your code will be 57288 (Sling operation for stress incontinence [eg, fascia or synthetic]).

Watch out: Cystoscopy can only be reported if documented for a medical reason. If he was doing it to simply check placement of the MiniArc, it would be checking his work and not separately billable.

The removal of the right vulvar lesion can be coded separately, but you will need to know how it was removed and the size of the lesion to pick the correct code.