Ob-Gyn Coding Alert

Question: A patient has a vaginal vault prolapse. The ob-gyn will be doing a laparoscopic McCall culdoplasty and uterolysis. How should I code this?

Wyoming Subscriber  Answer: The only code for a McCall culdoplasty is for a vaginal route. Therefore, you must use the unlisted-procedure code 49329 (Unlisted laparoscopy procedure, abdomen, peritoneum and omentum).
 
A McCall culdoplasty closes the space between the rectum and vagina through a vaginal incision to prevent the small bowel from pushing the vagina out. In other words, it prevents an enterocele from forming. This procedure will also suspend the top of the vagina. You should note, however, that if the patient does not have an enterocele, payers will likely deny the procedure.
 
In addition, you can bill the ureterolysis (50715-50725) separately only when the patient has retroperitoneal fibrosis, ovarian vein syndrome, or a retrocaval ureter. In all other instances, code the ureterolysis as regular lysis of adhesions and apply the same guidelines. If the ob-gyn did not document the adhesions as extensive, vascular, anatomy- distorting, etc., most payers will deny them as incidental to the primary procedure.  - The answers for Reader Questions and You Be the Coder were provided by Melanie Witt, RN, CPC, MA, an ob-gyn coding expert based in Fredericksburg, Va.