Urology Coding Alert

Question: Recently one of my physicians performed a lap vesicovaginal fistula repair. I know there’s no actual code for it, but it’s comparable to 57320 (Closure of vesicovaginal fistula; vaginal approach). How would I go about pricing it? Is there a generic formula for pricing unlisted codes for lap procedures? Like double the comparable code pricing or that sort of thing?

AAPC Forum Subscriber

Answer: There is no generic formula because an unlisted code means there is no code for the procedure. However, anytime you report an unlisted code, you should decide the benchmark code and how it compares. In this case, you should benchmark it to 51900 (Closure of vesicovaginal fistula, abdominal approach).

If you are comparing it to the abdominal approach in this case, consider: Was this specific case more work, less work, or the same work as an open abdominal approach?

Laparoscopic procedures, in general depending on the specific procedure, are paid 14-24 percent more than the same open procedure. Therefore, the unlisted laparoscopy procedures should be billed 14-24 percent more than the benchmarked open procedure. You should consult with your surgeon to make this call for the increase using the 14-24 percent guidelines.