Ob-Gyn Coding Alert

Question: My physician did a vaginal hysterectomy (58260) and a combined anteroposterior repair (57260). During the same session she assisted a gyn/urologist in a paravaginal repair (57284) culdoplasty, which the physician says is the same as a enterocele and a tension-free vaginal tape (57288). How should I code for my surgeon's services?

Nebraska Subscriber

Answer: Paravaginal defect repair (57284, paravaginal defect repair [including repair of cystocele, stress urinary incontinence, and/or incomplete vaginal prolapse]) is not the same as an enterocele repair with tension-free vaginal tape, but rather is an extensive procedure that corrects for multiple tissue weaknesses.  This surgery can't be coded correctly without seeing the operative report because one of the procedures your surgeon wants to bill (the anterior repair) is included in the paravaginal defect repair done by the urologist.
 
Review the operative note for both procedures to see what has been documented.
 
Your physician can bill for the vaginal hysterectomy and posterior repair (if this is documented) with 58260 (vaginal hysterectomy) and 57240-51 (posterior colporrhaphy, repair of cystocele with or without repair of urethrocele, -multiple procedures) and report assisting at the paravaginal repair (57284-80, ... assistant surgeon) if this was not a Medicare patient. Medicare will not allow a surgeon who is already billing as a primary surgeon to bill also as an assistant at the same operative session.