Reimbursement Advisor

Mesh is an internal graft for coding purposes

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Q In a recent column, you indicated that the CPT code 57295 (revision [including removal] of prosthetic vaginal graft, vaginal approach) could be used to report revision or removal of an eroded vaginal mesh. What ICD-9 codes would be used for this procedure?

A Normally, erosion is reported as a complication of the procedure, even when it occurs after the global period for the procedure. Since the mesh is considered an internal graft, you will look under the code category 996.6x (infection and inflammatory reaction due to internal prosthetic device, implant, and graft) or 996.7x (other complications of internal [biological] [synthetic] prosthetic device, implant, and graft). The code selection will depend on documentation of the problem with the mesh.

If there was evidence of infection or inflammation, the correct code would be 996.65, specific for a genitourinary device, implant, or graft.

If there was evidence of pain, fibrosis, stenosis, hemorrhage, or erosion, the diagnosis specific to a genitourinary device would be 996.76.

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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