Ob-Gyn Coding Alert
Start Getting More Specific for Apical Prolapse
Question: Need help in coding the following Dx: Apical Prolapse. Would that be 618.00 (Vaginal prolapse NOS), or should I use Dx 618.01? I have been seeing this a lot on operative reports and just want to make sure I am coding this correct. Patient had a TVH and an uterosacral ligament suspension. Please advise!
New Mexico Subscriber
Answer: Apical prolapse is defined as the descent of the uterus, cervix, or vaginal vault. Your ob-gyn is going to have to do better than this to get to the right code. This is right up there with referring to the patient’s pelvic prolapse without further explanation. Without any specificity, you can’t code it. And this is first lesson for ICD-10 as well and now is the time to do the teaching and nagging. Also note that if this were just uterine prolapse the ICD-9 code would be 618.1, but in ICD-10 there will be no code for uterine prolapse without mention of vaginal wall prolapse.
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