Ob-Gyn Coding Alert

Question: During an office exam on a patient complaining of spotting, the ob-gyn noticed the erosion of prolene mesh to the vaginal cuff from prior abdominal sacral colpopexy. Then he did surgery to remove this mesh the following week. He used Mayo scissors to trim down all of the mesh and vaginal margins. He closed the vaginal cuff with #0 vicryl suture from the left vaginal angle and completed it at the right. Along with this repair, he performed a tension-free vaginal tape procedure for stress urinary incontinence with hypermobile urethra. How should I code these services? What are the most accurate diagnosis and procedure codes for this surgery?

Virginia Subscriber

Answer: You should use 57295 (Revision [including removal] of prosthetic vaginal graft; vaginal approach) for revision of a vaginal graft (vaginal approach). For the sling procedure, you should report 57288 (Sling operation for stress incontinence [e.g., fascia or synthetic]). Remember to append modifier 51 (Multiple procedures).

Put it together: Your code order, based on the relative value units (RVUs), is 57288, 57295-51.

You must use the diagnosis code that represents the information the ob-gyn provides. In this case, the stress urinary incontinence ICD-9 code is 625.6. You would link this code to 57288. Mesh erosion is 996.39 (Mechanical complication of genitourinary device, implant and graft; other).