Urology Coding Alert

Question: How should we code a robotic hysterosacrocolpopexy? Should I use the open uterine suspension code (CPT 58400 ) plus S2900? Or should I use 57425 or the unlisted procedure lap uterus code (58578)? Also, when doing an open approach through the abdomen, why can't we get paid for the insertion of mesh?

Nebraska Subscriber

Answer: You should report 57425 (Laparoscopy, surgical, colpopexy [suspension of vaginal apex]) for the  laparoscopic colpopexy. Then, also report S2900 (Surgical techniques requiring use of robotic surgical systems [list separately in addition to the code for primary procedure])  since your physician used robotic technology.

Why: A urologist performs -- and you can code -- a laparoscopic colpopexy for both uterovaginal prolapse as well as vaginal prolapse after a hysterectomy. That makes 57425 the appropriate code in this case.

Remember: You should report S2900 only to non-Medicare payers. Medicare will not pay you for S2900.

If your urologist uses mesh in the repair, you cannot separately report this procedure, as you noted. The reason is that the mesh insertion code -- +57267 (Insertion of mesh or other prosthesis for repair of pelvic floor defect, each site [anterior, posterior compartment], vaginal approach [List separately in addition to code for primary procedure]) -- is an add-on code. You cannot report +57267 as an independent code. You can use it only with one of the following primary codes: 45560, 57240-57265, or 57285. Since 57425 and 57280 (Colpopexy, abdominal approach) are not part of that list, you cannot report +57267 with those two procedures.