Wiki 57280, colpopexy

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Korbc

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this procedure was done ultimately only on one side because the left uterosacral ligament was more difficult to identify as the ligament had much more laxity and was not providing much support. Should I code this with a modifier 52?
 
I don't see anything in the description of 57280 that requires more than one attachment.
That being said, I will note there has been much heated debate in my urogyn practice regarding vaginal cuff suspension to uterosacral ligament(s), whether open or laparoscopic WITHOUT graft/mesh.
AUGS has issued guidance stating USLS if without graft or not suspended from sacrum should instead be coded as unlisted.
"Suspension procedures which do not involve placement of a graft or which do not involve suspension from the sacrum should be reported with an alternative code."
While the CPT description to me simply states suspending to a "strong structure", AUGS has interpreted this to mean sacrum. I submitted a coding question to ACOG regarding the laparoscopic approach for USLS and they also replied it must be attached to the sacrum, not uterosacral ligaments.

While I agree when USLS is being done as prophylactic treatment as part of closure during total hysterectomy to prevent prolapse in the future, then coding for colpopexy is not indicated. In my personal opinion, if USLS is being done to treat a prolapse, the open and laparoscopic colpopexy codes seem to be correct, both AUGS and ACOG state otherwise.

The vaginal approach code 57283 specifies uterosacral, so does not have this same coding issue.
 
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