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Ob-Gyn Coding Alert

Reader Question:
Options Exist for Coding Graft With Colporrhaphy

Question: While treating patients for prolapse and stress incontinence (57260, 57282 and 57288), the physician states he performed a "patch graft" or a "pelvicol graft" on the posterior colporrhaphy. How should we code for this? Oklahoma Subscriber Answer: Currently, CPT does not provide a specific code for using the graft as part of the posterior colpor-rhaphy (57260, Combined anteroposterior colporrhaphy). Consequently, you have three options for coding the additional graft. First, you can report just 57260 and disregard the extra work associated with the graft. Second, you can add modifier -22 (Unusual procedural services) to 57260 if your physician's documentation sufficiently details the extra work associated with the graft. Or, third, you can use the unlisted-procedure code 58999 (Unlisted procedure, female genital system [nonobstetrical]) to represent the procedure. If you submit the unlisted-procedure code, you run the risk that the payer will consider the procedure experimental and refuse to reimburse for it. And, if you use modifier -22 every time your ob-gyn performs a colpor-rhaphy, this becomes the standard technique for this physician, and the payer will begin to ignore the modifier. You should use modifier -22 to denote a procedure that is unusual for the physician who is billing for it.  

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