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I could use some help on coding a Lap Uterosacral Ligament Colposuspension.
I did extensive research and found that the unspecified code 49329 should be used for this procedure. However I get denials from Medicare that there is another appropriate code for this procedure. The only one that comes close would be 57425, but again, I don't think that code is correct. Im good with the hysterectomy code its only the ULC im having issues with. Any help would be greatly appreciated.
OPERATIVE PROCEDURE:
Total laparoscopic hysterectomy, bilateral salpingectomy and uterosacral
ligament colposuspension
ANESTHESIA:
General endotracheal intubation.
ESTIMATED BLOOD LOSS:
50 mL.
FINDINGS:
Upon entering the abdomen, the right hemidiaphragm and right and left
dome of the liver were entirely normal. The visualized portions of the
omentum and small and large bowel were also normal. There was no
peritoneal studding. The appendix was retrocecal and was not removed.
Looking in the pelvis, the fibroid uterus was enlarged to approximately
10 weeks' size and had a pedunculated fundal fibroid that measured 10 x
8 cm. The bilateral ovaries were normal. The tubes were normal. There
was no ascites. The hysterectomy and salpingectomy were accomplished
without complication. At the end of the operation, there was perfect
hemostasis and the sponge and instrument counts were correct.
DESCRIPTION OF PROCEDURE:
With the patient prepped and draped in the modified lithotomy position
in the standard sterile fashion after ascertaining adequate general
endotracheal anesthesia, a pause was held to reidentify the patient and
reconfirm the purpose of the surgery.
Attention was then turned to the umbilicus, which was everted and
injected generously with Marcaine and a 5 mm vertical incision was made.
Skin edges were elevated on towel clips and a trocar was inserted
directly into the abdomen with visual confirmation. The upper abdomen
was explored and then the patient was placed in steep Trendelenburg.
The pelvis was examined and then the procedure was begun by incising
along the mesosalpinx on the right side, then through the uteroovarian
ligament and then the right round ligament was cauterized and incised.
Then the uterus was pushed upward and a bladder flap was created. The
uterine artery was identified and skeletonized and then cauterized
generously and then incised. The pubocervical fascia was incised down
to the vaginal epithelium. Hemostasis was secured and attention was
turned to the right side.
On the right side, the mesosalpinx was incised all the way over to the
uterus. The utero-ovarian ligament was cauterized and incised. Then
the round ligament was cauterized and incised. The uterus was pushed
upward and then the bladder flap was completed. The cervical cup was
easily visible. The uterine artery was cauterized and incised and then
the pubocervical fascia was incised circumferentially into the vagina,
freeing up the uterus and tubes. Uterus was brought down through the
vagina without difficulty; however, the massive fibroid was then
disconnected from the uterine fundus at the level of the peduncle and it
too was brought out through the vagina without difficulty. The bilateral ovaries were reconfirmed to be normal. There was no
endometriosis. Suture was passed up through the vagina. Taking the
uterosacral ligament with suture and incorporating the uterosacral
ligament into the pubocervical fascia with sutures on each side gave
good elevation to the prolapsed vagina. The vagina itself was reefed
with a V-Loc suture with good hemostasis and then the suture was sutured
back on itself. There was perfect hemostasis. The sponge and
instrument counts were correct. The ovaries were normal. The gas was
carefully and thoroughly deflated from the abdomen and then the trocars
were removed and the incisions were treated with the vertical inverted subcuticular suture of 4-0 Monocryl and then treated with Dermabond.
The patient tolerated the procedure well. She was awakened, extubated
and taken to recovery room in good condition
I did extensive research and found that the unspecified code 49329 should be used for this procedure. However I get denials from Medicare that there is another appropriate code for this procedure. The only one that comes close would be 57425, but again, I don't think that code is correct. Im good with the hysterectomy code its only the ULC im having issues with. Any help would be greatly appreciated.
OPERATIVE PROCEDURE:
Total laparoscopic hysterectomy, bilateral salpingectomy and uterosacral
ligament colposuspension
ANESTHESIA:
General endotracheal intubation.
ESTIMATED BLOOD LOSS:
50 mL.
FINDINGS:
Upon entering the abdomen, the right hemidiaphragm and right and left
dome of the liver were entirely normal. The visualized portions of the
omentum and small and large bowel were also normal. There was no
peritoneal studding. The appendix was retrocecal and was not removed.
Looking in the pelvis, the fibroid uterus was enlarged to approximately
10 weeks' size and had a pedunculated fundal fibroid that measured 10 x
8 cm. The bilateral ovaries were normal. The tubes were normal. There
was no ascites. The hysterectomy and salpingectomy were accomplished
without complication. At the end of the operation, there was perfect
hemostasis and the sponge and instrument counts were correct.
DESCRIPTION OF PROCEDURE:
With the patient prepped and draped in the modified lithotomy position
in the standard sterile fashion after ascertaining adequate general
endotracheal anesthesia, a pause was held to reidentify the patient and
reconfirm the purpose of the surgery.
Attention was then turned to the umbilicus, which was everted and
injected generously with Marcaine and a 5 mm vertical incision was made.
Skin edges were elevated on towel clips and a trocar was inserted
directly into the abdomen with visual confirmation. The upper abdomen
was explored and then the patient was placed in steep Trendelenburg.
The pelvis was examined and then the procedure was begun by incising
along the mesosalpinx on the right side, then through the uteroovarian
ligament and then the right round ligament was cauterized and incised.
Then the uterus was pushed upward and a bladder flap was created. The
uterine artery was identified and skeletonized and then cauterized
generously and then incised. The pubocervical fascia was incised down
to the vaginal epithelium. Hemostasis was secured and attention was
turned to the right side.
On the right side, the mesosalpinx was incised all the way over to the
uterus. The utero-ovarian ligament was cauterized and incised. Then
the round ligament was cauterized and incised. The uterus was pushed
upward and then the bladder flap was completed. The cervical cup was
easily visible. The uterine artery was cauterized and incised and then
the pubocervical fascia was incised circumferentially into the vagina,
freeing up the uterus and tubes. Uterus was brought down through the
vagina without difficulty; however, the massive fibroid was then
disconnected from the uterine fundus at the level of the peduncle and it
too was brought out through the vagina without difficulty. The bilateral ovaries were reconfirmed to be normal. There was no
endometriosis. Suture was passed up through the vagina. Taking the
uterosacral ligament with suture and incorporating the uterosacral
ligament into the pubocervical fascia with sutures on each side gave
good elevation to the prolapsed vagina. The vagina itself was reefed
with a V-Loc suture with good hemostasis and then the suture was sutured
back on itself. There was perfect hemostasis. The sponge and
instrument counts were correct. The ovaries were normal. The gas was
carefully and thoroughly deflated from the abdomen and then the trocars
were removed and the incisions were treated with the vertical inverted subcuticular suture of 4-0 Monocryl and then treated with Dermabond.
The patient tolerated the procedure well. She was awakened, extubated
and taken to recovery room in good condition