Urology Coding Alert

When placing a pubovaginal sling for the treatment of female stress incontinence, modifier -51 (multiple procedures) must be used with care when also coding the graft material for the sling.

Report 57288 (sling operation for stress incontinence [e.g., fascia or synthetic]) for the sling itself. For a fascia lata graft, code 20920 (fascia lata graft; by stripper) or 20922 (... by incision and area exposure, complex or sheet). For a rectus fascia graft, CPT 20926 (tissue grafts, other [e.g., paratenon, fat, dermis]). The graft codes are modifier -51 exempt: They will be paid in full, even if other procedures are performed as well. Claim 57288 for a pubovaginal sling, no matter how the sling is secured (anchors to the bone, securing to the rectus fascia, etc.).

Are Cysto and Harvesting Included in 57288?

Recently there has been some controversy regarding billing of pubovaginal sling procedures. Formerly, urologists could also bill for a cystoscopy (52000), with modifier -51 appended, when placing a pubovaginal sling. The American Urological Association (AUA) is no longer recommending this approach. Because the cystoscopy is always performed when placing the sling, it is considered included in the procedure. Although the national Correct Coding Initiative does not bundle 52000 (or the sling material harvesting codes) into 57288, correct coding dictates that the cystoscopy is included in the sling procedure.

Michael A. Ferragamo, MD, FACS, clinical assistant professor of urology at the State University of New York in Stonybrook, reports that 57288 includes the graft harvesting codes (20920-20926) as well as 52000. These procedures should not be billed with 57288 because they are integral to the procedure.

You may not bill separately for synthetic material, either, the AUA says. The descriptor for 57288 refers to synthetic or fascia. It must be noted that CPT is not clear on whether the material harvesting codes are bundled into 57288.

CPT guidelines, however, state that when grafts are obtained through a separate incision, and obtaining the graft is not listed as part of the CPT code description for the surgery (e.g., 54316), separate billing of the harvesting is appropriate. At this time, the CPT description of 57288 does not include harvesting of the graft.

I agree 100 percent with following your societys guidelines, says Sandy Page, CPC, CCS-P, co-owner of Medical Practice Support Services, a Denver-based coding and compliance consultancy. But I also want the physician to receive appropriate reimbursement for services provided. She recommends that urologists look at both options the AUAs and CPTs and decide which is best for them.