Urogynecological Medical Coding: Use of Mesh in Pelvic Floor Repairs


 

As you know, CPT Code 57267 is used when there is an insertion of the mesh or other prosthesis for repair of the pelvic floor, each site having a mesh place whether it is in the anterior or posterior compartment and this is via a vaginal approach.  Read this expert medical billing and coding training article to get more in-depth knowledge of this code.

Now, the 57267 is an add-on code. That means that it cannot be billed independently. But it must be added on to another code that we will see in a moment. Remember, with the add-on code, you do not append modifier -51. And you do not reduce the fee. The unadjusted 2010 Medicare fee schedule is about $281 for code 57267.

Now, you use the 57267, the insertion of the mesh in addition to billing for 45560 that's a perirectal rectocele repair; 57240, an anterior repair; posterior repair 57260; and posterior 57265, anterior-posterior and an enterocele repair. And also, it can be added to 57285, which is a transvaginal, paravaginal defect repair.

Remember, for cleaner medical coding claims, you cannot bill and you cannot expect to be paid for using a mesh using code 57267 with any of the colpopexy codes or with any code showing a total abdominal hysterectomy or total vaginal hysterectomy.

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Now, how do we code for these repairs? Well, let us look at a posterior repair with a mesh that if you have the ICD-9 diagnosis 618.82. This ICD diagnostic code is the weakness or incompetence of the rectal-vaginal fascia. And that's reported, the posterior repair with the mesh is 57250 and code 57267. The anterior repair with mesh with an ICD diagnosis of 618.81, incompetence or weakening of the pubocervical fascia is coded by the code 57240 and the add-on code 57267.

Let's look at some more coding and compliance clinical scenarios. Here we did a pubovaginal sling, an anterior and posterior repair, and an anterior and posterior mesh. Now, we did show that the anterior and posterior repair, the 57260, pays more than the vaginal sling. So that goes first as our primary procedure.

Notice the diagnosis, 618.01 a mid-line cystocele and 618.04 rectocele. We then billed for the pubovaginal sling, 57288. With modifier 51 placed by Medicare diagnosis 625.6, stress urinary incontinence.

Now, we also bill for the anterior mesh, 57267. And the anterior mesh was made and placed. And the diagnosis indicated where that mesh went and for what reason, 618.82, incompetence or weakening of the pubocervical fascia. We put a posterior mesh, now we should bill that 57267 as per the medical coding rules and guidelines.

We do not put the -51 modifier because it’s an add-on code. But we use modifier -59 to tell the carrier that we put another mesh in another location. We’re not double charging. We put the mesh in another location. And that location is told by the ICD diagnosis 618.82, incompetence or weakening of the rectovaginal fascia.

Let's look at another medical coding and billing scenario. Here we have a patient who had a posterior colporrhaphy and rectocele repair, vaginal repair of an enterocele and a posterior mesh placement. The posterior colporrhaphy and rectocele repair is 57250 with a rectocele diagnosis. We also did a vaginal repair of an enterocele 57268 adding -51 modifier. And the diagnosis is an enterocele 618.6. And then we place the posterior mesh and that was an add-on code using its primary code, the 572502 which is added on to. And again, the diagnosis is 618.82, weakness or incompetence of the rectovaginal fascia.

Let's look at another clinical scenario and how this was coded. This patient had a pubovaginal sling, had a really a pelvic floor reconstruction with a vaginal repair of a cystocele, rectocele, and enterocele, a perineal plasty and a Kelly plication. She had meshes placed in the anterior and posterior compartments.

Now, the code 57265 is for a vaginal repair of a cystocele, rectocele and enterocele, and also includes the repair of a perineal plasty and a Kelly plication. And that diagnosis is 618.01 cystocele, and 618.06, an enterocele. We billed in as a secondary procedure, the sling, because the 57265 pays more than the sling and that should go first. And then we bill the two compartments with placement of meshes with the two diagnoses 618.81, 618.82.

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