Reimbursement Advisor

How to code a new incontinence procedure

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Q Our physicians have started performing a procedure called the SURx radio frequency bladder neck suspension. The device manufacturer has recommended using either 57288 (sling operation for stress incontinence [eg, fascia or synthetic]) or 57284 (paravaginal defect repair [including repair of cystocele, stress urinary incontinence, and/or complete vaginal prolapse]), but this procedure doesn’t seem to fit either description. Do you have other suggestions?

A The radio frequency bladder neck suspension procedure is based on a device from SURx, Inc (Livermore, Calif). According to the company, their instrument restores continence by using low-power radio frequency energy to heat and shrink stretched tissue near the bladder and urethra. No sutures are used to suspend the bladder neck. The procedure can be done either transvaginally or laparoscopically.

Since this procedure does not use materials such as surgical mesh, cadaver tissue, bone screws, or staples, you cannot bill code 57288. Likewise, this is not a paravaginal defect repair, as suggested by 57284.

If you want to pick a code with a more appropriate description, try 51845 (abdomino-vaginal vesical neck suspension, with or without endoscopic control [eg, Stamey, Raz, modified Pereyra]) or 51990 (laparoscopy, surgical; urethral suspension for stress incontinence)—but if the payer considers this procedure investigational, you may run into trouble later should you be audited.

The safest course would be to bill unlisted code 53899 (unlisted procedure, urinary system) and send in documentation that supports the procedure as a viable standard of care for the presenting problem.

Ms. Witt, former program manager in the Department of Coding and Nomenclature at the American College of Obstetricians and Gynecologists, is an independent coding and documentation consultant. Reimbursement Adviser reflects the most commonly accepted interpretations of CPT-4 and ICD-9-CM coding. When in doubt on a coding or billing matter, check with your individual payer.

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