Urology Coding Alert

Question: The urologist performed urethrolysis with excision of an eroded sling. She then placed a new transobutator sling. Would this just be one code: 57287? Or, would it be 57288, 53500, and 57296?

California Subscriber

Answer: For this case, first, report 53500 (Urethrolysis, transvaginal, secondary, open, including cystourethroscopy [e.g., postsurgical obstruction, scarring]) for the urethrolysis. Append modifier 52 (Reduced services) if your urologist did not perform a cystourethroscopy.  

Next, report 57288 (Sling operation for stress incontinence [e.g., fascia or synthetic]) for the new sling replacement.

Important: The actual removal would not be billable when you are replacing a new device (the sling). This scenario is similar to when your urologist replaces a ureteral JJ stent. You should just bill for the replacement instead of both the removal and replacement.

Reporting 57296 (Revision [including removal] of prosthetic vaginal graft; open abdominal approach) is incorrect coding in this scenario. Code 57296 is an open, abdominal approach used for the removal of a vaginal graft/mesh, not removal of a vaginal sling.