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 +57267) 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 +57267). 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 57240 anterior colporrhaphy CPT code 57285 paravaginal repair, vaginal approach CPT code 57250 posterior colporrhaphy CPT code 57260 combined cystocele and rectocele repairs CPT code 57265 combined cystocele, rectocele, enterocele Repairs CPT code 45560 rectocele repair Does not include CPT 57268 (trans-vaginal mesh for enterocele) Link 57267 to appropriate parent CPT code AND ICD-9-CM DX codes: Anterior weak Pubocervical fascia 618.81, cystocele 618.01 Posterior weak Rectovaginal fascia 618.82, rectocele 618.04
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 618.01 Rectocele 618.04 Weak pubocervical tissue 618.81 Weak rectovaginal tissue 618.82 Prolapse of the vaginal vault after hysterectomy 618.5 Stress urinary incontinence 625.6 Procedure (surgery) Coding: Paravaginal defect repair, vaginal approach 57285 Colopexy, vaginal, extra-peritoneal 57282 Posterior colporrhaphy 57250 Insertion of mesh (graft) 57267 x 2* (use with 57285 and 57250) Sling operation 57288 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 +57267 is only for transvaginally placed mesh You CANNOT use +57267 to code for mesh slings o Specifically 57288 (midurethral sling) or 57287 (sling revision)
You CANNOT use +57267 to code for mesh in transabdominal colpopexy/enterocele repairs, specifically; o Sacrocolpopexy 57280 (Open ASC) or 57425 (Laparoscopic / Robotic ASC) o Repair enterocele 57270 (x-ab) or 57268 (x-vag) Mesh graft removal codes, CPT (RVU): 57295 -transvaginal complex in OR 57296 -transabdominal complex in OR 57061 -transvaginal simple destroy vaginal lesion in clinic 10120 -transvaginal simple remove FB from skin in clinic 20680 -transabdominal or vaginal bone anchor/screw removal in OR 57287 -transvaginal sling removal or revision in OR 53500 -transvaginal urethrolysis in OR Use appropriate reconstruction CPT code/s done after mesh is removed o 53430 -urethroplasty female urethra o 51865 -cystorrhaphy complicated o 51860 -cystorrhaphy simple o 51820 -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 618.2 Rectocele 618.04 Weak pubocervical tissue 618.81 Weak rectovaginal tissue 618.82
Complete uterine prolapse 618.1 Stress urinary incontinence 625.6 Genital prolapse 618.89 Other disorders of urethra and urinary tract 599.82 Treatment: -Abdominal sacral colpopexy, CPT code 57425 -Supracervical hysterectomy, CPT code 58541 -Sling, CPT code 57288 -Cystoscopy, CPT code 52000 Mesh Explants Codes to Use ICD-9-CM DX codes for mesh removal: o 629.31 mesh EROSION into organ o 629.32 mesh EXPOSURE in vagina o 625.any female pelvic pain (see ICD code listings) o 598.2 postop urethral stricture o 996.30 complications from GU device o 788.62 slow urinary stream o 788.29 urine retention specified CPT code Medicare national RVU total Medicare national RVU total Medicare Fees (non- facility) Medicare Fees ( facility) (Non -facility) (facility) 10120 4.26 2.93 $152.61 $104.96 20680 17.55 12.15 $628.69 $435.25
45560 20.03 20.03 $717.53 $717.53 51820 30.7 30.7 $1099.76 $1099.76 51860 21.33 21.33 $764.10 $764.10 51865 25.48 25.48 $912.76 $912.76 52000 5.67 3.59 $203.12 $128.60 53430 27.59 27.59 $988.35 $988.35 53500 21.37 21.37 $765.53 $765.53 57061 3.24 2.83 $116.07 $101.38 57240 19.26 19.26 $689.95 $689.95 57250 19.59 19.59 $701.77 $701.77 57260 24.15 24.15 $865.12 $865.12 57265 26.45 26.45 $947.51 $947.51 57267 7.42 7.42 $265.81 $265.81 57268 13.93 13.93 $499.01 $499.01 57270 23.17 23.17 $830.01 $830.01 57280 27.59 27.59 $988.35 $988.35 57285 19.45 19.45 $696.75 $696.75 57287 19.43 19.43 $696.04 $696.04 57288 20.44 20.44 $732.22 $732.22 57295 13.78 13.78 $493.64 $493.64 57296 27.58 27.58 $987.99 $987.99
57425 28.07 28.07 $1005.55 $1005.55 58541 25.05 25.05 $897.36 $897.36