Urology Coding Alert

Question: Normally, when our doctors do a urethral sling and an arcus tendinous bladder sling, we use CPT 57288 and 57282-52 (Reduced services), respectively. Recently, one of our doctors did the urethral sling and the arcus tendinous bladder sling with a uterine suspension. He said the uterine suspension added more time and difficulty to the case. We thought about coding 58400 but noticed it has "separate procedure" by it. Should I also append modifier -22 (Unusual procedural services) to 57282-52?

North Carolina Subscriber Answer: First you should question your physician to see if the arcus tendinous repair -- which you've been coding 57282 (Sacrospinous ligament fixation for prolapse of vagina) -- is actually 57284 (Paravaginal defect repair [including repair of cystocele, stress urinary incontinence, and/or incomplete vaginal prolapse]).

If 57282 is what is actually being done, you should use 57288 (Sling operation for stress incontinence) for the sling procedure, 57282-51 for the sacrospinous tendinous repair, and 58400-51 (Uterine suspension, with or without shortening of round ligaments, with or without shortening of sacrouterine ligaments; [separate procedure]; multiple procedures) for the uterine suspension. The sacrospinous tendinous repair is unrelated to the other procedures, and you should certainly report it separately.

But if the procedure involving the arcus tendinous repair is 57284, you should adjust your coding accordingly. Code 57288 is bundled into 57284 and cannot be unbundled. In that case, you should use 57284 for the arcus tendinous repair and 58400-51 for the uterine suspension. Code 57284 pays more than all the other codes mentioned above.