Ob-Gyn Coding Alert

Choose 1 code for sling procedures, no matter what type The causes of female urinary incontinence are many, so you may be overwhelmed by treatment coding options. But if you can correctly decipher both the treatment and the cause, you-ll easily choose the best code every time. Here's how.
 
From both a clinical and coding perspective, it helps to think of incontinence procedures in categories, says Nina Mutone, MD, medical director of the urogynecology division at St. Vincent's Hospital in Indianapolis. Your physician can choose from the following surgical options for incontinence:

 - retropubic suspension
 - needle procedures
 - slings Report 51840, 51841 for Retropubic Urethropexy Your physician may choose a retropubic suspension to treat a female patient with urinary incontinence. If the operative report states that the sole surgical approach was abdominal and the physician performed either a Marshall-Marchetti-Krantz (MMK) or Burch procedure, you can immediately narrow your search to two codes: 51840 (Anterior vesicourethropexy, or urethropexy [e.g., Marshall-Marchetti-Krantz, Burch]; simple) and 51841 (- complicated [e.g., secondary repair]).
 
During an MMK procedure, the surgeon places sutures into the vaginal wall at the level of the urethra or bladder neck and anchors them to the pubic bone. For a Burch sling procedure, the surgeon would anchor the sutures to the Cooper's ligament.
 
How to choose: Your physician's documentation is the key to choosing 51840 or 51841. You can consider a retropubic suspension procedure to be complicated in the following situations:
 - If it is a secondary repair following a previous surgery
 - If there is extensive bleeding during surgery
 - If the patient has adhesions from a previous surgery
 - If the patient has vaginal prolapse
 - If the procedure takes an excessive amount of time to complete
 - If the patient is obese
 - If the surgeon encounters aberrant anatomy. Tip: A good way to double-check your code selection is to determine whether the patient's diagnosis correlates to procedures 51840 and 51841. Possible diagnoses for MMK and Burch procedures include stress incontinence (625.6), vaginal prolapse (618.x), and mixed incontinence (788.33). Don't Let 51845 Needle You Another surgical method your physician may opt for is needle suspension. Physicians don't use these procedures as often as they used to because they haven't worked well, Mutone says. 
 
If your physician does perform a Stamey, Raz, Gittes or modified Pereyra needle procedure, however, you should report 51845 (Abdomino-vaginal vesical neck suspension, with or without endoscopic control [e.g., Stamey, Raz, modified Pereyra]) or 57289 (Pereyra procedure, including anterior colporrhaphy) for a Pereyra procedure, says Melanie Witt, RN, CPC-OGS, MA, an independent coding consultant in Guadalupita, N.M.
 
Physicians perform these procedures using either an abdominal or a combined abdominal-vaginal approach. 52788 Is Your Answer for Slings Physicians often perform sling procedures on female patients with incontinence. [...]