Urology Coding Alert

Bonus: You may soon be able to report sling procedures separately

If your urologist or urogynecologist performs paravaginal defect repair procedures, prepare for a new wave of coding rules in January.

CPT Codes 2008 will offer you approach-specific codes for these procedures, along with new telephone care codes and potentially an “e-visit” code. Get the scoop on upcoming 2008 CPT changes to ensure you’re ahead of the curve.

Revise Your 57284 Thinking

CPT 2008 will revise the descriptor for 57284 (Paravaginal defect repair [including repair of cystocele, stress urinary incontinence, and/or incomplete vaginal prolapse]) and add two more codes for paravaginal defect repairs, according to insiders. The new codes will specify para-vaginal defect repair via vaginal approach and para-vaginal defect repair via laparoscopic approach.

How it works: The descriptor for 57284 will change to reference only the open abdominal procedure. And you’ll have one new code for a laparoscopic approach and another one for a vaginal approach.

Old way: Now, CPT doesn’t offer a code for a laparoscopic paravaginal defect repair, leading some physicians to use 57284 for the laparoscopic approach, but 57284 was meant to be for an open approach, experts say.

“This is a messy issue with which we have been struggling,” says Morgan Hause, CCS, CCS-P, privacy and compliance officer for Urology of Indiana LLC, a 31-urologist, two-urogynecologist practice in Indianapolis. “To code the laparoscopic approach correctly, coders have had to use an unlisted-procedure code, which really delays claim payment and increases follow-up efforts in billing.”

Expect Code Limitations to Mimic CCI

New way: The new codes (and 57284) will include any additional urethropexy or cystocele repair that your physician performs as part of the paravaginal defect repair, one source familiar with the changes tells Urology Coding Alert. “This is consistent with current Correct Coding Initiative (CCI) edits, which bundle 51840-51841 and 57240 into 57284 with a status indicator of ‘0,’ ” Hause says.

All three codes will also include any bladder or urethra fixation, commonly referred to as a “Burch” or “Marshall-Marchetti-Kranz (MMK)” procedure. If the surgeon operates on the urethra at the same time, payers consider this code part of the procedure, the source says.

“I think the new codes will be beneficial as they eliminate the need to use unlisted-procedure codes, and each approach or surgical type will have a code that is appropriately valued under Resource-Based Relative Value Scale (RBRVS) to account for physician work, practice and malpractice expense,” says Melanie Witt, RN, CPC-OGS, MA, a coding expert based out of Guadalupita, N.M.

Tip: Coders will have to rely on solid documentation by the physician to be able to choose the appropriate code based on the surgical approach, Witt says.

Hint: The updated 2008 CPT book and CCI should list the codes you cannot bill with these codes.

Note: You will be able to bill separately for a “sling procedure” for stress incontinence, the source says. Previously, CPT included this procedure (57288) in the descriptor for 57284, but in January, none of the three codes will include the sling procedure.

Watch out: Of course, the CCI may bundle 57288 into 57284 and the two new codes.