Urology Coding Alert

The only surefire approach to coding surgical procedures for stress urinary incontinence in women is to code according to the approach used by the urologist. Stress urinary incontinence (SUI) is urine leakage that occurs during an activity such as laughing, lifting or sneezing, activities that put pressure, or stress, on the bladder, says Maureen Beckwith, CPC, urology billing specialist with the University of California at San Francisco department of urology. SUI can result from a wide variety of causes, including vaginal deliveries, obesity and even constipation, she adds.

One way to locate the correct procedure code is to use the method of approach documented by the urologist in the operative notes in addition to the patient's diagnosis, Beckwith says. Stomach Reimbursements With 51840 One surgical method of approach used by urologists is the abdominal approach. Immediately, if the operative documentation says the sole surgical approach used was abdominal, you can narrow your code search to CPT 51840 (Anterior vesicourethropexy, or urethropexy [e.g., Marshall-Marchetti-Krantz, Burch]; simple) and CPT 51841 ( complicated [e.g., secondary repair]). The following is a summary of what 51840 involves: Using an abdominal approach, the urologist places sutures into the vaginal wall at the level of the urethra or bladder neck and anchors them to either the pubic bone, in which case the procedure is referred to as Marshall-Marchetti-Krantz (MMK), or to Cooper's ligament, designating the surgery a Burch procedure. Shirley Fullerton, CMBS, CPC, CPC-H, practice management and coding specialist in Las Vegas, and Beckwith proffer some examples of circumstances that classify MMK and Burch procedures as complicated:   If it is a secondary repair     If there is extensive bleeding during surgery     If the patient has adhesions from a previous surgery     If the patient has a prolapse     If the physician has to go through a number of layers.   Time can really be a factor in determining whether a procedure is complicated or simple, Fullerton says. "You can also check to see if there are a lot of additional codes that are not typically required for a standard procedure."

"Even obesity can sometimes be a factor in determining whether a procedure is simple or complicated, which is why it is so important that coders review the operative report," Beckwith advises coders. "If the complication results from something like a previous surgery or injury, list the complication as the third diagnosis code."

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 [...]