Urology Coding Alert

Question: My urologist documented a laparoscopic transvaginal repair of a rupture to the urinary bladder. Should I code this as 51860?

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Answer: No, you should not report 51860 (Cystorrhaphy, suture of bladder wound, injury or rupture; simple). This code is for an open procedure so would not be appropriate for transvaginal approach. Instead, you will need to report 51999 (Unlisted laparoscopy procedure, bladder).

Don’t miss: Remember when using unlisted codes for procedures that do not have specific CPT^® codes, in addition to the CMS-1500 claim form or the electronic equivalent submission, you should also submit a detailed operative report to the payer. You can also include a cover letter describing in laymen’s terms the operation performed, the absence of a specific CPT^® code for the procedure, the expertise and work required, or other pertinent clinical details from your urologist.

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.