Coding and Compliance: Accurate Way to Code Pelvic Floor Reconstruction


Thinking of using +57267 (Insertion of mesh or other prosthesis for repair of pelvic floor defect …)? Given that +57267 can get you about $260 more, it’s a fine move to consider for some claims — as long as you understand how to use it accurately. Read this expert medical coding and billing expert advice to know more.

The code 57267, the insertion of a mesh can also be billed because this is an add-on code. It can also be added on to a new code, the 57285 which is a vaginal paravaginal defect repair.

Medical Coding and Billing Example: There is a patient who has a procedure of a pubovaginal sling, paravaginal defect repair and an anterior placement of a mesh. When we have multiple procedures, as most of you know, we pick the procedure and make that the primary procedure, that we code in the procedure that has the highest relative value unit will pay the most. In this medical coding case, that will the pubovaginal sling, 57288 and your diagnosis is stress urinary incontinence in female, 625.6.

And then we did a paravaginal defect repair, 57285 for a laterally placed cystocele, 618.02 and the we put an anterior mesh, the 57267. And we indicated where this mesh was - it was an anterior mesh by the diagnosis, 618.81, incompetence or weakening of the pubocervical fascia.

57284 is the paravaginal defect repair code. This is an open abdominal approach. You can now bill a paravaginal defect repair, 57284 and a sling, 57288. Previously, the 57284 had been bundled. It is no longer bundled and when you bill these two procedures, you will bill your paravaginal repair first as the primary procedure as this has a higher relative value unit. And your secondary procedure would be the sling, the 57288.

Now, also remember that when we do an abdominal paravaginal repair this includes or may include the use of a mesh which does not require a coding of this 57267.

Now, we also have paravaginal repairs done vaginally as we just previously mentioned, the 57285. Now you may also bill for the mesh if you use the mesh with the 57285 using the mesh code, 57267. We also have a laparoscopic paravaginal defect repair, 57423.

Let’s go over some of the colpopexy, the suspension of the vaginal apex. Now, you have two vaginal approaches. And these are payable by Medicare when you also do and bill and be paid for a total abdominal hysterectomy and a total vaginal hysterectomy.

We have two vaginal approaches -- one, an extraperitoneal, the 57282 colpopexy. And notice - and you should see this in the operative report that the anchoring material or anatomy was the sacrospinous ligament or a repair of the iliococcygeus of the muscle.

We also have a vaginal repair which is intraperitoneal utilizing the uterosacral ligaments or doing a levator myorrhaphy. And this is called the McCall culpoplasty. Notice that if we use the mesh in any of these previous repairs, the 57282 or the 57283, the mesh is included and you shouldn’t bill this as a separate service.

There's also an abdominal colpopexy payable also by Medicare when you do bill and are paid for a total vaginal hysterectomy or a total abdominal hysterectomy. Also note in this medical coding instance that if you use a mesh, it's not separately chargeable. This abdominal approach is often called the Moskowitz culpoplasty.

We have a laparoscopic surgical colpopexy, 57425. And this is payable if done with a laparoscopic supracervical hysterectomy - and you have the code, a laparoscopic vaginal assisted hysterectomy - and you have the code, or a laparoscopic total hysterectomy - and you have the code. Remember again that in - neither of these two procedures on this page, if you use a mesh, can you bill for that using the 57267.

What happens when you do an abdominal colpopexy and a hysterectomy? Well, if you do an abdominal total or partial hysterectomy and if there is a co-existing vaginal wall prolapse and you repair this - in other words, you do a restorative procedure, most carriers will pay you with the diagnosis of vaginal wall prolapse, 618.00 or 618.09.

Now, if there is no wall prolapse and you indicate this for your ICD diagnostic codes, 618.00 and the code V07.8, which indicates that you are doing this prophylactically or preventative, many carriers especially the Blue will not want to pay you when you are doing a preventive surgery rather than a restorative. So be careful in using the codes and be careful as to what you are saying in your operative report.

Remember that 57267 code is an add-on code. That means you do not append modifier -51 or reduce the fee. And the unadjusted 2009 Medicare fee schedule is going to be about $281. Also remember that this code cannot be used alone but it must be used in conjunction with another primary CPT code.

And those codes are 45560 which is the perirectal rectocele repair without a posterior colporrhaphy. This code, the 45560 really should not be used by the gynecologist or urogynecologist or urologist unless he really does a perirectal rectocele repair without a posterior colporrhaphy.

The 57267 is also used with an anterior repair, posterior, combination A-P repair, combination A-P repair and an enterocele, 57265. Note that the 57267 is not payable with any of the colpopexy codes or with any of the hysterectomy, total abdominal or total vaginal codes for hysterectomy.

Now, how do we code for posterior repair with mesh? That would be the use of an (Epigee) or the Gynecare posterior prolift. You would bill that with two medical coding and billing options, 57250 and 57267.

How would you code for an anterior repair with mesh? That would be the Perigee or the Gynecare anterior prolift. You would bill that 57240 and 57267.

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