Urology Coding Alert

Question: The urologist performed a robotic assisted removal of a vaginal mesh from the patient’s pelvis and closed an inadvertent cystostomy during the same encounter. He listed T83.498A and N21.0 as the diagnoses. How should I code the procedure?

West Virginia Subscriber

Answer: For this clinical scenario, code with 57426 (Revision [including removal] of prosthetic vaginal graft, laparoscopic approach) for the robotic assisted removal of the vaginal/pelvic mesh. This code connects with ICD-10 diagnostic code T83.498A (Other mechanical complication of other prosthetic devices, implants, and grafts of genital tract, initial encounter).

Unfortunately, CPT^® 2016 does not include a code for a robotic/laparoscopic cystotomy repair. Instead, you should bill the “unlisted” code 51999 (Unlisted laparoscopic procedure, bladder). Benchmark the work and pricing to 51860 (Cystorrhaphy, suture of bladder wound, injury or rupture; simple) for a simple procedure or 51865 (... complicated) if the procedure can be considered complicated. Connect the bladder procedure code with diagnosis S37.23XA (Laceration of bladder, initial encounter). ICD-10 diagnostic code N21.0 (Calculus in bladder) would be an incorrect diagnosis for this scenario.