Ob-Gyn Coding Alert

Question: My ob-gyn performed a total vaginal hysterectomy (TVH) with right salpingo-oophorectomy (RSO) and enterocele repair. He also did an anterior and posterior (A&P) and sacrospinous ligament fixation. I billed 58263, 57260, and 57282. The patient's insurance is bundling 57282 into 58263. Is this correct, or should I fight to get this claim paid in full?

Tennessee Subscriber

Answer: Check your denial reason. This may be a clue as to what this payer was expecting.

Neither CPT nor the Correct Coding Initiative (CCI) bundle 57282 (Colpopexy, vaginal; extra-peritoneal approach [sacrospinous, iliococcygeus]) into 58263 (Vaginal hysterectomy, for uterus 250 g or less; with removal of tube[s], and/or ovary[s], with repair of enterocele). That does not mean, however, that private payers do not have their own "in-house" edits.

CPT: What you will see is that if your ob-gyn does a vaginal hysterectomy with enterocele, you may not also bill an intra-peritoneal colpopexy (57283, Colpopexy, vaginal; intraperitoneal approach [uterosacral, levator myorrhaphy]), according to CPT -- but that being said, CPT is silent with regard to the sacrospinous ligament fixation (SLF) procedure (57282).

Your diagnosis coding could be a likely factor in this denial. In order to bill for the colpopexy, you must have a diagnosis of vaginal vault prolapse (618.5, Genital prolapsed; Prolapse of vaginal vault after hysterectomy). If the ob-gyn did the SLF to prevent a future prolapse, then you should include the colpopexy as part of the TVH.