Urology Coding Alert

Question: I’m looking for help coding for an excision of exposed urethral sling mesh via laser destruction. While the provider was performing cystolitholapaxy for a bladder stone he came across the mesh which “slung across from the 5 to the 7 o’clock position right at the bladder neck, probably about 1 cm to 1.5 cm bridge right there at the bladder neck.” Endoscopic scissors were not strong enough to cut the mesh, so he used a 550 micron laser fiber to break off the mesh in the bladder and then removed the mesh from the bladder and completed the cystolitholapaxy procedure. How do we code for this?

Tennessee Subscriber

Answer: The correct coding for this would be 52317 (Litholapaxy: crushing or fragmentation of calculus by any means in bladder and removal of fragments; simple or small (less than 2.5 cm)). The size of the bladder stone was not mentioned, so report diagnosis N20.1 (Calculus of ureter). Also bill for the difficult removal of the sling from the bladder neck via a cystoscopic approach with 52315 (Cystourethroscopy, with removal of foreign body…from urethra or bladder; complicated). Add modifier XU (Unusual non-overlapping service, the use of a service that is distinct because it does not overlap usual components of the main service) to 52317 to bypass the bundle with 52317 and ensure payment of both procedures.

Also: Report CPT^® code 57287 (Removal or revision of sling for stress incontinence (eg, fascia or synthetic) if the surgeon uses a vaginal procedure/approach.