Ob-Gyn Coding Alert

Question: When an ob-gyn revises a sling procedure by removing a portion of the sling, should I use 57287? The op note reads that the physician removed a portion of the sling and did not replace any portion of it.

Texas Subscriber Answer: You should use 57287 (Removal or revision of sling for stress incontinence [e.g., fascia or synthetic]) when the ob-gyn revises the sling, which is the case in the above question. During a sling revision, the surgeon may remove and partially or completely replace the sling using fascia or a synthetic graft through an abdominal or vaginal approach, according to the Coders' Desk Reference.

In the above case, you should also scrutinize the operative report to determine if you can bill 53500 (Urethrolysis, transvaginal, secondary, open, including cystourethroscopy [e.g., postsurgical obstruction, scarring]) as well. The ob-gyn often performs this procedure with the sling revision because of scar tissue that forms around the urethra following a previous surgery. And the National Correct Coding Initiative does not bundle 53500 with 57287.