Ob-Gyn Coding Alert

Question: How do I code for an exploratory laparotomy, bilateral salpingo-oophorectomy (BSO), culdoplasty (Halbans), paravaginal repair and a Burch procedure? The diagnosis code for this surgery is cystocele and stress urinary incontinence.

New York Subscriber

Answer: The exploratory laparotomy is included with the other procedures. The BSO is coded as 58720 (salpingo-oophorectomy, complete or partial, unilateral or bilateral [separate procedure]). The Halbans is a form of abdominal enterocele repair and the code is 57270 (removal of enterocele, abdominal approach [separate procedure]). Note that both these codes are separate procedures so you may have to use modifier -59 (distinct procedural service) on the second code to get it paid. You should not charge for 57270 unless the patient had an enterocele because the procedure is frequently done to prevent one. A paravaginal defect repair is coded as 57284 (paravaginal defect repair [including repair of cystocele, stress urinary incontinence, and/or incomplete vaginal prolapse]) and it includes the Burch procedure. Assuming that none of these procedures are bundled, and all procedures are properly documented with medically necessary diagnoses, the order on the claim will be:

57284
57270-59-51 (multiple procedures)
58720-51