Ob-Gyn Coding Alert

Question: My ob-gyn performed a vaginal hysterectomy with anteroposterior repair, McCall culdoplasty and perineorrhaphy. How should I code this? Iowa Subscriber Answer: McCall culdoplasty is enterocele repair using a vaginal approach. Therefore, the only way you can charge for this procedure is if the patient had an enterocele (618.6, Vaginal enterocele, congenital or acquired). There are two options for coding these procedures. In either case, however, payers generally include perineor-rhaphy in the vaginal hysterectomy because they view it as the ob-gyn tidying up his or her work. Your first option is to report 58270 (Vaginal hysterectomy, for uterus 250 grams or less; with repair of enterocele) with 57260-51 (Combined anteroposterior colporrhaphy; multiple procedures). Code 58270 includes the hysterectomy, the perineorrhaphy, and the McCall culdoplasty, and 57260 covers the anteroposterior repair. Note that in 2003, the CPT code choices will change. If the uterus is 250 grams or less, you would still use 58270. But if the uterus is greater than 250 grams, you would report 58294 for the hysterectomy and enterocele repair. Alternatively, you could code the procedures using 58260 (Vaginal hysterectomy, for uterus 250 grams or less) the 2002 code would have been 58260 as well and 57265-51 ( with enterocele repair). If the uterus is more than 250 grams, you should report the hysterectomy with 58290.