Urology Coding Alert

Question: I saw your article “Follow This Roadmap to Capture Correct MMK Pay” last month and I have a follow-up question. I am new to urology coding and am having trouble distinguishing between an MMK procedure and a Burch procedure. How can I tell the difference based on the urologist’s documentation, and how do I relate that to choosing the right code?

Illinois Subscriber

Answer: A Marshall-Marchetti-Krantz (MMK) procedure and a Burch procedure are indeed similar, so your confusion is understandable. The difference really is where the urologist places the sutures.  

During an MMK procedure, the surgeon places sutures into the vaginal wall at the level of the urethra and bladder neck and anchors them to the pubic bone. For a Burch sling procedure, the surgeon would anchor the sutures to the Cooper’s ligament.

Check the notes: “An MMK dictation will usually use terminology such as placing stitches ‘at the bladder neck,’ or ‘in the periurethral tissue,’ or ‘in the paravesical fascia,’ then attaching them to the symphysis pubis or periosteum of the pubis or pubic bone,” explains Nina Mutone, MD, MPH, urogynecologist with Urology of Indiana in Indianapolis. “This is to be distinguished from a Burch, which attaches the paravesical sutures to Coopers (or the iliopectineal) ligament. MMK and Burch are both often referred to as retropubic urethropexy or colposuspension procedures. Both are always performed through an abdominal incision.”

Coding: The good news is that it really doesn’t matter whether your urologist performed an MMK or a Burch procedure when you are looking for the right code for an abdominal retropubic suspension. You’ll choose from two codes, regardless: 51840 (Anterior vesicourethropexy, or urethropexy [e.g., Marshall-Marchetti-Krantz, Burch]; simple) and 51841 (… complicated [e.g., secondary repair]).