Urology Coding Alert

Question: A patient undergoes a cystocele repair and a transobturator vaginal tape (TVTO) for stress incontinence. During surgery, the urologist finds an enterocele which requires repair. Is there a code for just an anterior repair plus enterocele repair?

Alaska Subscriber

Answer: If you are reporting this procedure to Medicare, start with CPT 57288 (Sling operation for stress incontinence [e.g., fascia or synthetic]) for the TVT sling. Then, report 57240 (Anterior colporrhaphy, repair of cystocele with or without repair of urethrocele) for the anterior repair.

Note: The Correct Coding Initiative (CCI) includes the vaginal repair of an enterocele in the sling procedure (52788), and you cannot override this edit using any modifier. Also keep in mind that CPT and Medicare consider 57268 (Repair of enterocele, vaginal approach [separate procedure]) a "separate procedure," and you usually cannot bill for it when you're billing for other procedures.

Alternative: For private carriers that may not follow the Medicare, CCI, or separate procedure designations, you should use the following coding:

• 57288 for the sling procedure

• 57240-51 (Multiple procedures) for the anterior repair

• 57268-51 for the vaginal repair of the enterocele.