Ob-Gyn Coding Alert

Question: My ob-gyn performed an anterior colporrhaphy for reduction of cystocele, reduction of enterocele by culdoplasty, and retropubic urethropexy. I have 57240, 57425 and 51840. Is this right?

Virginia Subscriber

Answer: Not quite, because, to code correctly, you have to know the approach for two of the procedures to get it right. The codes you have listed are a mix of abdominal and laparoscopic approaches.Therefore, you should check the op report for the approach and the description of what your ob-gyn did.

The anterior colporrhaphy is correct (57240, Anterior colporrhaphy, repair of cystocele with or without repair of urethrocele), but an enterocele repair (culdoplasty, meaning repair of the cul-de-sac) is not a colpopexy (fixation of the vaginal vault).

The code you have listed, 57425 (Laparoscopy, surgical, colpopexy [suspension of vaginal apex]), is for a laparoscopic procedure. Ask yourself, did he actually suspend the vaginal vault to a structure (colpopexy) or did he close up the enterocele sac? If the latter, you would use one of the culdoplasty codes (57268, Repair of enterocele, vaginal approach [separate procedure]; or 57270, Repair of enterocele, abdominal approach [separate procedure]).

Code 51840 (Anterior vesicourethropexy, or urethropexy [e.g., Marshall-Marchetti-Krantz, Burch]; simple) is not a laparoscopic retropubic urethropexy, but an abdominal procedure. So, again, which approach did your surgeon take for the urethropexy? If it was laparoscopic, you should instead report 51990 (Laparoscopy, surgical; urethral suspension for stress incontinence).