Urology Coding Alert

Urology Coding:

Traverse This Transvaginal Procedure

Question: My urologist recorded a laparoscopic transvaginal correction of a urinary bladder tear. I was originally going to code this as 51860, but my coworker thinks this will be denied. Can you help?

RCI Subscriber

Answer: Your coworker is correct. Submitting the claim using 51860 (Cystorrhaphy, suture of bladder wound, injury or rupture; simple) would be incorrect. This is because this code is for an open procedure, so it would not be appropriate for a transvaginal approach. You will need to submit the claim using 51999 (Unlisted laparoscopy procedure, bladder).

Keep in mind that when you're using unlisted codes for procedures, you should not only submit the CMS-1500 claim form or its electronic equivalent, but also provide a comprehensive operative report to the payer. It's also beneficial to attach a cover letter that explains the procedure in detail, the lack of a specific CPT® code for the procedure, the skill and effort required, or any other relevant clinical details from your urologist, in a language that’s easy for anyone to understand.

In this letter, benchmark a CPT® code that represents a procedure that is similar in work and time to the unlisted procedure you are reporting. In your case, benchmark your unlisted code to the open code 51860 and request compensation comparable to that which you would receive for the open procedure.

Remember: When submitting an unlisted code to the payer, you should not only submit the claim on paper, but also include the most appropriate comparison code in Box 19 of the CMS-1500 form. Stephanie Storck, CPC, CPMA, CUC, CCS-P, ACS-UR, longtime urology coding expert and consultant in Glen Burnie, Maryland, explains, “reporting an unlisted code will require manual review by the health plan and may delay processing of the claim.”

Lindsey Bush, BA, MA, CPC, Development Editor, AAPC

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