Ob-Gyn Coding Alert

Question: We billed 57282 for a sacrospinous fixation  and 57260 for an anterior and posterior repair. Why did the carrier significantly reduce the fee?

California Subscriber

 
Answer: Code 57282 (sacrospinous ligament fixation for prolapse of vagina) has a slightly higher relative value unit than 57260 (combined anteroposterior colporrhaphy), but the carrier may not attach as high a value to the surgery, so it considers 57282 as the lower-valued service. But if you listed 57282 first on the claim, you should have been paid the full allowable amount for it with a fee reduction on 57260. The payers usually discount the second procedure by 50 percent because they are now paying you only for the additional intraoperative work.