Ob-Gyn Coding Alert

Question: I need clarification on codes 618.81-618.82. Are these added codes we should use in lieu of 618.01 or 618.04? Do these need to be tied to 57267 only? Should we state this problem on the history and physical or postoperative diagnosis?


Tennessee Subscriber

Answer: Code 618.81 (Other specified genital prolapse; incompetence or weakening of pubocervical tissue) describes the weakening of the anterior vaginal wall. Code 618.82 (- incompetence or weakening of rectovaginal tissue) describes the weakening of the posterior vaginal wall. 

You would use add-on code +57267 (Insertion of mesh or other prosthesis for repair of pelvic floor defect, each site [anterior, posterior compartment], vaginal approach [list separately in addition to code for primary procedure]) to indicate that either the anterior wall or posterior wall tissue was weak or insufficient to hold stitches. Otherwise, these stitches would correct the cystocele or rectocele (or enterocele). Because the tissue could not hold the stitches, the ob-gyn had to apply the mesh in addition to the stitches.

In this situation, you would link 618.81 or 618.82 to the add-on code--not the code for the basic cystocele or rectocele repair (such as 45560, Repair of rectocele [separate procedure], 57240, Anterior colporrhaphy, repair of cystocele with or without repair of urethrocele, 57250, Posterior colporrhaphy, repair of rectocele with or without perineorrhaphy, 57260, Combined anteroposterior colporrhaphy). You would link those codes to 618.01 (Prolapse of vaginal walls without mention of uterine prolapse; cystocele, midline) and/or 618.04 (- rectocele).

Rule of thumb: When you use 618.01, you-re saying the patient's bladder is bulging into the vaginal canal. Code 618.81 says that the supporting tissues have an additional weakness, not just a defect where the bladder comes through. This additional weakness is why the ob-gyn needs to apply a mesh support in addition to the usual anterior colporrhaphy sutures.

Best bet: If the physician is going to use the add-on code, the documentation or op report should include the information that the additional weakness required the ob-gyn to use mesh.