Urology Coding Alert

Question: What is the best code for a takedown of a pubovaginal sling? We were using the unlisted procedure code, but are there different options depending on how the doctor performs the procedure?

Texas Subscriber

Answer: This year, CPT introduced a code for a release of a pubovaginal sling (57287, removal or revision of sling for stress incontinence [e.g., fascia or synthetic]). If the sling was originally placed to treat stress incontinence, code 57287 for vaginal release and/or removal of the sling material. If the urologist approaches suprapubically to cut or loosen the suture, use 10120 (incision and removal of foreign body, subcutaneous tissues; simple) or 10121 (incision and removal of foreign body, subcutaneous tissues; complicated). Usually, a urologist performs one (57287) or the other (10120 or 10121), but sometimes performs both.

Other associated procedures often performed with 57287 and separately billable are 53660 (dilation of female urethra including suppository and/or instillation; initial), 57220 (plastic operation on urethral sphincter, vaginal approach [e.g., Kelly urethral plication]) or 52000 (cystourethroscopy [separate procedure]).

You may also use modifier -78 (return to the operating room for a related procedure during the postoperative period) or -52 (reduced services) with 57287.

If 57287 is performed during the postoperative period (90 days) of 57288 (sling operation for stress incontinence [e.g., fascia or synthetic), add modifier -78. Only the intraoperative portion of the surgical procedure (about 65 percent) would be reimbursed.

Add modifier -52 when performing only a urethrolysis. A urethrolysis may be necessary for obstructive symptoms following an overly aggressive anterior repair. The correct way to code this, now that 57287 exists, is 57287 with modifier -52. You must file this claim on paper, with a short note in laymans terms explaining what you did and why and, most important, what percentage of the 57287 you performed. The urethrolysis portion of 57287 often constitutes 80 percent of the work of the procedure itself. Many carriers will pay you the full fee if you perform 80 percent of the work.