Medical Coding Training: Brace Your Stress Incontinence Procedures Coding Know-how


 

Coding for stress incontinence procedures could be tricky even for veteran coders. This expert coding and compliance article mentions a lot of procedures, many of which are not really done too often. Years ago, we used to the anterior vesicourethropexy or an MMK, the Marshall-Marchetti-Krantz or the Burch procedure. The code for that was 51840.

We do have a laparoscopic MMK or Burch, the 51990. We have a laparoscopic sling, 51992. We talked about just recently the paravaginal defect repair. And let’s talk about the sling procedures, the 57288. In the past historically, we have a Stamey, a Raz, or a modified Pereyra with the code 51845.

As per the recent coding updates, for all sling procedures, use the code 57288. Use the 57288 whether you do a Sparc procedure, a TVT, a TOT, stratasis, a urotek or the monarch. All of these are variations on the sling procedure but should be coded with the code 57288.

Your diagnosis or your medical necessity or your reason for doing the 57288 should be stress urinary incontinence in the female, 625.6. On occasion, some carriers will not accept the stress urinary incontinence and they are looking for the code for intrinsic sphincter deficiency code 599.82. But most carriers will pay with the diagnosis for a sling of 625.6.

57288 was approved for performance in an ambulatory surgical center on July 1st, 2005. The facility fee paid to the facility when you do a 57288 in an ambulatory surgical center for 2008 is $979.81. That’s paid to the facility, not to the physician. They were paying $717 to the facility. In 2009, this is going to jump up to around $1,100.

Coding and Compliance Tip: Now, when you do a vaginal sling, 57288 in the female, remember that this does not include for which you may bill in addition to the 57288 a fascial harvest, anterior repair, posterior combination, A-P repair, combination A-P repair and an enterocele repair.

Your vaginal colpoplasty is the 57282 of the 57283. And if you drain the bladder by a trocar cystostomy, then you would bill the code, 51102. The code 51102 is new for a percutaneous trocar cystostomy.

Remember that the 57288 does include for which for which you should not bill and you will not be paid because these are bundled is the cystoscopy, a vaginal enterocele repair and a perineoplasty.

EOB:  An EOB is an explanation of how we bill them, how we got paid. And this happens to be a private carrier. See, we billed a 57288. The 0 at the end indicates that the operator or surgeon - we billed $1,306 which was the allowed charge and we were paid $1,306. We also billed of an anterior repair of a cystocele midline. And we billed a 57240 and the allowed charge was $391.50 and we would pay half of that as the secondary procedure, $195.72.

But what about an abdominal colpopexy and a vaginal sling? Suppose the patient underwent a vaginal sling repair and an abdominal colpopexy. Note that we billed the abdominal colpopexy first because it has higher relative value unit than the sling. According to the expert advice of our speaker in a medical coding conference,  the 57280 will be billed first with the diagnosis of vaginal wall prolapse, 618.00 and then we would report the sling procedure, the 57288 modifier -51 diagnosis stress urinary incontinence in the female.

To keep yourself updated with the medical coding guidelines, visit our medical coding training online page.

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