1All vaginal vault suspensions can be coded
The American College of Obstetricians and Gynecologists (ACOG) requested new codes to address the various techniques of vaginal vault suspension. Until this year, only 1 vaginal colpopexy code was available: sacrospinous ligament fixation. For any other type of suspension, we had to bill for the procedure using either the unlisted code 58999 or the code that was closest, 57282 (sacrospinous ligament fixation for prolapse of vagina).
As of January 1, the 2 code revisions, 57282 and 57283, will address any suspension technique (TABLE). Which you choose will depend on whether the suspension occurs outside the peritoneal cavity (by attaching it to the iliococcygeus muscle or sacrospinous ligament), or inside (using the uterosacral ligament or performing a high midline levator myorrhaphy).
Note that the code for the intraperitoneal approach cannot be billed with code 58263 (vaginal hysterectomy with bilateral salpingo-oophorectomy and enterocele repair).
Barbara S. Levy, MD
Medical Director, Women’s Health Center, Franciscan Health System, Federal Way, Wash. Dr. Levy is ACOG’s member on the AMA RBRVS Update Committee; ex-officio member, ACOG Committee on Coding and Nomenclature; and a member of the OBG Management Board of Editors.
The near-universal acceptance of the resource-based relative value scale (RBRVS) means that accurate and complete coding is essential for accurate and complete payment. Lack of appropriate codes for all of the gynecologic surgery procedures we perform has been an impediment to appropriate reimbursement.
This year in particular, the American College of Obstetricians and Gynecologists (ACOG) made important strides in helping us code for the procedures we perform.
- New codes for hysteroscopic sterilization and endometrial cryoablation signify recognition by the American Medical Association and Current Procedural Terminology (CPT) that these technologies represent major advances in women’s health. They allow us to supply services in the office setting with appropriate reimbursement to cover our costs.
- Pelvic floor reconstruction procedures have become more sophisticated, and it has been difficult to accurately describe our surgical approaches with existing codes. These codes have been revised, allowing us to distinguish between intraperitoneal and extraperitoneal suspension of the vaginal vault. In addition, a new code describes the use of graft material (any type) to augment anterior, posterior, or apical repairs.
- New Fetal Doppler codes, describing studies of the umbilical and middle cerebral arteries, allow us to code for the assessment of fetal anemia and fetal growth restriction.
A new code was created for mesh augmentation, when the patient’s tissue is weak or inadequate for cystocele, rectocele, or enterocele repair. Code 57267 is an “add-on” code, meaning it is never used without an additional “base” code. It is billed with 45560 (rectocele repair), 57240 (anterior colporrhaphy), 57250 (posterior colporrhaphy), 57260 (combined anterior and posterior repair), or 57265 (combined anterior and posterior repair with enterocele repair).
Note that the code’s description indicates “each site.” Thus, if mesh is required in both the anterior and posterior compartments, code 57267 is listed twice.
2Cryoablation promoted from “developing technology”
Now rescued from Category III (temporary code 0009T), endometrial cryoablation has its own code, 58356, in the surgery section.
You should not bill separately for endometrial biopsy (58100), dilation and curettage (58120), saline-infusion sonogram/hysterosalpingogram (58340), abdominal ultrasound (76700), or pelvic ultrasound (76856); all are included in 58356. Note that the nomenclature states that ultrasound guidance is also included.
3Less hassle for less-invasive sterilization
Hysteroscopic sterilization (Essure; Conceptus, San Carlos, Calif)—which requires no abdominal incisions and can be performed in an office setting—now has its own code, 58565. Previously, the Healthcare Common Procedure Coding System (HCPCS) code S2555 and the code for an unlisted hysteroscopy (58579) were used to fill this coding gap. Physician practices will be happy to note that this code was given 57.77 relative value units (RVUs) when performed in a nonfacility setting—enough to cover the cost of the implants.
Do not report this with diagnostic hysteroscopy (58555) and/or dilation of cervix (57800). Since the code is valued as a bilateral procedure, add a modifier -52 (reduced services) if the device is placed unilaterally.
4More options for fetal Doppler
The addition of 2 codes for fetal Doppler of the umbilical and middle cerebral arteries (76820 and 76821) is most welcome for maternal-fetal medicine specialists evaluating fetal anemia and fetal growth restriction. Until now, these 2 scans were reported using the Doppler echocardiography codes 76827 (Doppler echocardiography, fetal, pulsed wave and/or continuous wave with spectral display; complete) or 76828 (Doppler echocardiography, … ; follow-up or repeat study).