Sling procedure is one of the most common procedures performed by the urologists or the urogynecologists in their attempt correct stress urinary incontinence. We would use the code 57288 whether we are doing a sling procedure, the Sparc, the TVT, the TOT, the Stratasys, the UroTech and the Monarc, and any other procedures that comes along using a vaginal sling we will always use the code CPT Code 57288. Go through this expert urogynecological medical coding and billing article for more.
Now, your diagnosis for the 57288 and you see the diagnosis gives you the medical necessity for doing that procedure or it's the reason that we did the 57288. And most often, the most carriers will accepted and wish you to bill the 625.6, Stress Urinary Incontinence. On occasion, a carrier will not accept the 625.6 and not pay the 57288. And most often that carrier is looking for the diagnosis 599.82, Intrinsic Sphincter Efficiency.
Also note that the 57288 has been approved for being performed in an ambulatory surgical center who will receive a facility fee when that procedure is performed in an ASC.
Now, when you do the female sling procedure, remember that there are many other procedures that you may also accomplish that are not included in the 57288 sling procedure for which you may bill. So, following the medical coding guidelines, if you do a fascial harvest from the anterior abdominal fascia to use that fascia as your sling, you can also bill along with the 57288 to 57209, 57206.
You can also bill along with the sling procedure an anterior and posterior repair. You can also bill along with the sling an anterior and posterior repair, an AP repair with an enterocele repair and an abdominal colpopexy.
According to the recent medical coding updates, you may also bill the sling procedure and transvaginal colpopexy, the 57282 or the 57283. If it's your style to drain the bladder at the suprapubically after a sling procedure, you may also bill a trocar cystostomy, the 51102.
Now, the next three procedures are included in the 57288. And you should not bill those codes in addition to the sling procedure. These codes are bundled into 57288 and cannot be unbundled with any modifier. These codes include cystoscopy, a vaginal enterocele repair and a perineal plasty.
.An EOB is an explanation of what we bill and how we got paid. And in this particular patient we did a vaginal sling repair for stress incontinence. And we bill the 57288. The “0” at the end of the procedure indicates it was done by an operating surgeon.
We also bill an anterior repair of a midline cystocele. And we were also paid for that. The amount charged was $391.50. And because this was a secondary procedure, we were paid half $195.75. This slide shows that you can bill a vaginal sling and an anterior repair and be paid for both.
Note that the abdominal colpopexy has relative value units of $26.14, meaning that it pays more than the sling procedure with relative value units of $19.69. So, in this particular clinical scenario, the medical coding will be for the abdominal colpopexy first, the 57280, with the diagnosis of vaginal prolapsed, 618.00. And then the sling procedure being coded as a secondary procedure, the 57288 with modifier 51, that Medicare will place or you may have to place for private carries with the diagnosis of 625.6, stress urinary incontinence.
For more urogynecological coding and compliance updates, our medical billing and coding training page.