The obgyn that I am coding for does most of his surgeries laparoscopic with the robot. He does a lot of uterosacral vaginal vault suspensions using this approach. The only code that I can find for a laparoscopic suspension is 57425 but the description that I have found in the AAPC coder discusses using a mesh graft which is not what he is doing. Frequently he does this during a TLH procedure and may do an enterocele repair at the same time...........
"{this is after the uterus is removed through the vagina and the vaginal cuff is closed with sutures} Next the ureters were identified. The uterosacral ligaments were identified. The sponge stick was place din the vagina and used for elevation. Sutures were placed through the uterosacral ligament and then attached to the vaginal cuff for future support. Two sutures of 0 Ethibond were placed bilaterally. Good support was noted. Next the sutures were placed in the peritoneum to repair the enterocele. Following this, irrigation was performed. Hemostasis was assured. Normal function of the ureters was noted. Vaginal examination was performed and good support of the vaginal cuff was noted....."
1. Do I need to be using an unlisted code for the vaginal vault suspension (and if so which one as there is no "unlisted laprascopic procedure of the vagina")
2. Can I bill the enterocele separately (and if so is this also an unlisted code since it is laparoscopic?)
Thanks for your help
"{this is after the uterus is removed through the vagina and the vaginal cuff is closed with sutures} Next the ureters were identified. The uterosacral ligaments were identified. The sponge stick was place din the vagina and used for elevation. Sutures were placed through the uterosacral ligament and then attached to the vaginal cuff for future support. Two sutures of 0 Ethibond were placed bilaterally. Good support was noted. Next the sutures were placed in the peritoneum to repair the enterocele. Following this, irrigation was performed. Hemostasis was assured. Normal function of the ureters was noted. Vaginal examination was performed and good support of the vaginal cuff was noted....."
1. Do I need to be using an unlisted code for the vaginal vault suspension (and if so which one as there is no "unlisted laprascopic procedure of the vagina")
2. Can I bill the enterocele separately (and if so is this also an unlisted code since it is laparoscopic?)
Thanks for your help