Urology Coding Alert

Test your coding knowledge. Determine how you would code this situation before looking at the box below for the answer.

Question: What is the proper way to code for revision of sling, done transvaginally, with or without urethrolysis? The diagnosis is stress urinary incontinence (625.6).

Pennsylvania Subscriber

  Answer: For sling creation, the procedure would be coded 57288 (sling operation for stress incontinence [e.g., fascia or synthetic]) or, if it were done laparoscopically, 51992 (laparoscopy, surgical; urethral suspension for stress incontinence; sling operation for stress incontinence [e.g., fascia or synthetic]). But in this case, you want a code for a revision. However, the code you use depends on how the revision was done.

The most common method of revision is simple suture release. For this, you should use CPT code 10120* (incision and removal of foreign body, subcutaneous tissues; simple) or 10121 (incision and removal of foreign body, subcutaneous tissues; complicated). However, if the revision is extensive such as, if you need to reattach both ends of the sling material, with significant dissection, you should code 57288 with modifier -52 (reduced services) attached, to indicate that you did something like an entirely new sling operation but not quite.

If, on the other hand, you do need to re-do the sling entirely, which means you need to undo the first one, you should code 57288 with modifier -22, to indicate that the procedure was more complicated than a straight 57288. You should not use 53430 (urethroplasty, reconstruction of female urethra) or 53445 (operation for correction of urinary incontinence with placement of inflatable urethral or bladder neck sphincter, including placement of pump and/or reservoir) for the revision.