Coding for Surgical Procedures Involving the Use of Mesh

Transcription

1 Coding for Surgical Procedures Involving the Use of Mesh The AUGS Coding and Reimbursement Committee has received numerous coding questions over the years regarding how to code various surgical procedures that involve the use of Mesh. In an effort to provide education to our members, we have taken that information and combined it here in this article for your reference. Note this is for educational purposes only, and it is the responsibility of individual AUGS members to select the CPT codes that accurately describe the procedures they have performed. Slings and Sacrocolpopexies Midurethral sling (CPT code 57288) and Sacrocolpopexy with tissue graft (CPT codes 57280), or with the use of a mesh graft (CPT code 57425). Many times the question is asked if the mesh insertion add-on code (CPT code ) should be used in these instances. The answer is no. The CPT descriptors for these procedures include language for use of the mesh or graft; therefore, it cannot be coded for in addition to these base codes. Mesh insertion for vaginal repairs The code for mesh insertion for vaginal repair is ( CPT code ). It is an add-on code so it must be reported with the parent code in order to be reimbursed and these additional codes are not subject to the 50% payment reduction for multiple procedures. In this regard, the 51 modifier should not be added to a code that is an add-on, code, and the provider should expect the full reimbursement for this code. There are 6 Parent codes that may be used in this instance; CPT code anterior colporrhaphy CPT code paravaginal repair, vaginal approach CPT code posterior colporrhaphy CPT code combined cystocele and rectocele repairs CPT code combined cystocele, rectocele, enterocele Repairs CPT code rectocele repair Does not include CPT (trans-vaginal mesh for enterocele) Link to appropriate parent CPT code AND ICD-9-CM DX codes: Anterior weak Pubocervical fascia , cystocele Posterior weak Rectovaginal fascia , rectocele

2 When performing any of these procedures where a mesh or graft is also implanted, you should report the parent code and then report the add-on code for each compartment of the vagina in which mesh or graft was used. Example #1: A patient with prior hysterectomy now is symptomatic from a lateral cystocele with vaginal vault prolapse and rectocele as well as stress incontinence. She also has very weak tissue in her anterior and posterior vaginal compartments per the surgeon s examination. She undergoes vaginal repairs using mesh in the anterior and posterior compartments as well as vaginal vault suspension (vaginal paravaginal repair with mesh insertion plus extra-peritoneal colpopexy and rectocele repair with mesh insertion). The following is how this would be coded. Diagnoses: Cystocele, lateral Rectocele Weak pubocervical tissue Weak rectovaginal tissue Prolapse of the vaginal vault after hysterectomy Stress urinary incontinence Procedure (surgery) Coding: Paravaginal defect repair, vaginal approach Colopexy, vaginal, extra-peritoneal Posterior colporrhaphy Insertion of mesh (graft) x 2* (use with and 57250) Sling operation Mesh Implants Transabdominal: There is NO add-on mesh/implant code for transabdominal mesh/implants used to treat vaginal prolapse or for sling procedures o is only for transvaginally placed mesh You CANNOT use to code for mesh slings o Specifically (midurethral sling) or (sling revision)

3 You CANNOT use to code for mesh in transabdominal colpopexy/enterocele repairs, specifically; o Sacrocolpopexy (Open ASC) or (Laparoscopic / Robotic ASC) o Repair enterocele (x-ab) or (x-vag) Mesh graft removal codes, CPT (RVU): transvaginal complex in OR transabdominal complex in OR transvaginal simple destroy vaginal lesion in clinic transvaginal simple remove FB from skin in clinic transabdominal or vaginal bone anchor/screw removal in OR transvaginal sling removal or revision in OR transvaginal urethrolysis in OR Use appropriate reconstruction CPT code/s done after mesh is removed o urethroplasty female urethra o cystorrhaphy complicated o cystorrhaphy simple o ureteroneocystotomy Example #2: 65 year old female with POPQ: IVC and urodynamic stress incontinence desiring hysterectomy treated with robotic supracervical hyst, abdominal sacral colpopexy, tension-free TOT sling, and cystoscopy. Diagnosis: Cystocele Rectocele Weak pubocervical tissue Weak rectovaginal tissue

4 Complete uterine prolapse Stress urinary incontinence Genital prolapse Other disorders of urethra and urinary tract Treatment: -Abdominal sacral colpopexy, CPT code Supracervical hysterectomy, CPT code Sling, CPT code Cystoscopy, CPT code Mesh Explants Codes to Use ICD-9-CM DX codes for mesh removal: o mesh EROSION into organ o mesh EXPOSURE in vagina o 625.any female pelvic pain (see ICD code listings) o postop urethral stricture o complications from GU device o slow urinary stream o urine retention specified CPT code Medicare national RVU total Medicare national RVU total Medicare Fees (non- facility) Medicare Fees ( facility) (Non -facility) (facility) $ $ $ $435.25

5 $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $987.99

6 $ $ $ $897.36