Urology Coding Alert

Question: For transvaginal neurolysis, we have used 53899 (unlisted procedure, urinary system). Is this the appropriate code? The procedure performed was an Ingleman-Sundberg transvaginal neurolysis for severe urgency urinary incontinence. After French Foley placement, 10 cc. of Pitressin is injected in the anterior vaginal wall for hemostasis. An inverted-U incision is made from the base of the bladder through the mid urethra under the muscularis of the vaginal wall into the detrusor muscle. An inverted-U flap of vaginal epithelium and muscle is dissected off the detrusor muscle and between the urethropelvic ligament and vaginal epithelium laterally causing circumferential denervation of the trigone. The incision is closed and checked for leakage into the urethra or bladder.

Patty Schultz
Western Wisconsin Urology
Eau Claire, Wis.

Answer: There is no code to describe transvaginal neurolysis, and therefore, per CPT guidelines, an unlisted code is correct to report. Another option would be to use modifiers -22 (unusual procedural services) or -52 (reduced services) with an existing code such as 57284 (paravaginal defect repair (including repair of cystocele, stress urinary incontinence, and/or incomplete vaginal prolapse), or another code selected by the physician. The charge should be adjusted accordingly, and the operative note, with a cover letter explaining the circumstances, should be submitted with the claim. For the fee adjustment, although there are no guidelines regarding reductions or increases to fees, urologists commonly reduce (modifier -52) or increase (modifier -22) their fee by no more than 50 percent.