Ob-Gyn Coding Alert

Question: Can 57282 (Colpopexy, vaginal; extra-peritoneal approach [sacrospinous, iliococcygeus]) be applied to posterior slingplasty with polypropylene tape?

California Subscriber

Answer: The code for the extra-peritoneal ligament suspension would not be appropriate in this case because the uterosacral ligaments -quot; not the sacrospinous ligaments -quot; are the target of the surgery. But remember, 57283 (Colpopexy, vaginal; intraperitoneal approach [uterosacral, levator myorrhaphy]) is only a close approximation of the posterior slingplasty, and by all accounts is technically less difficult than the transvaginal approach.
 
Under CPT rules, you should code this procedure as 58999 (Unlisted procedure, female genital system [nonobstetrical]), not 57283. Note: You may not bill separately for using mesh in this case because it is integral to the procedure.
 
A posterior slingplasty, which is also referred to as an infracoccygeal sacropexy or a posterior intravaginal slingplasty, is a new minimally invasive approach for vault prolapse. This procedure applies the tension-free vaginal tape principle to the posterior part of the vagina.
 
What happens: The ob-gyn places a piece of surgical mesh at the top of the vagina, in a tension-free manner, through the pelvic sidewalls to support the top of the vagina. The ob-gyn then places the tape through a very small buttock incision (5 mm) lateral to the anus on one side, up along side the vagina to the apex, over the rectum at the top of the vagina, down alongside the vagina on the other side and out a buttock incision lateral to the anus on the other side.
 
A fibrous reaction occurs around the tape, which acts to strengthen and replace the weakened uterosacral ligaments, which suspends the top of the vagina in its normal anatomic position. The tape creates an artificial uterosacral neoligament to which the vaginal vault is reattached.