Ob-Gyn Coding Alert

Question: My ob-gyn performed a transobturator tape (TOT) sacrospinous colpopexy and an anterior and posterior (A&P) repair with insertion of mesh. We intend to report 57288, 57282-51, 57282-51, 57260-51, and 57267-51. Are these codes correct and in the best order?

Virginia Subscriber

Answer: Although many ob-gyns describe a sacrospinous colpopexy as "bilateral," you should only report 57282 (Colpopexy, vaginal; extra-peritoneal approach [sacrospinous, iliococcygeus]) once. This code does not take a bilateral modifier and includes fixation to both sides.

Code +57267 (Insertion of mesh or other prosthesis for repair of pelvic floor defect, each site [anterior, posterior compartment], vaginal approach [List separately in addition to code for primary procedure]) is an add-on code. You can report it once for the mesh in the anterior vaginal wall and once for the posterior wall. Because this is an add-on code, you should not append a modifier. Keep in mind, however, payers will look for medical necessity for the mesh.

How: So long as you have supporting documentation in the report, you would establish medical need with 618.81 (Other specified genital prolapse; incompetence or weakening of pubocervical tissue) and 618.82 (... incompetence or weakening of rectovaginal tissue).

Therefore, the correct order for the procedures this surgeon performed based on RVUs would be:

• 57260

• 57288-51

• 57282-51

• +57267 x 2 (assuming your physician documents the need).