Which codes for same-day multi-procedures?

Q I need CPT codes for the following surgical procedures performed on 1 patient on the same day: transvaginal hysterectomy, anterior pelvic floor reconstruction with Pelvicol graft tissue, posterior colporrhaphy, enterocele repair, and a bilateral vaginal vault suspension with the IVS tunneler system.

A This type of multifaceted surgery can be coded in several different ways, but you need to be aware of the relative value combinations you may come up with for the different options and the reduction that is applied by the payer when more than 2 procedures are reported on 1 patient on the same day.

You have 2 coding options here:

• 58270—Vaginal hysterectomy with enterocele repair
  
• 57260-51—Anterior and posterior (A&P) repair
  
• 57282-51—Vaginal vault suspension
  
• 57267—Pelvicol graft tissue (no modifier because this is a CPT “add-on” code)
  

or

• 58260—Vaginal hysterectomy
  
• 57265-51—A&P with enterocele repair
  
• 57282-51—Vaginal vault suspension
  
• 57267—Pelvicol graft tissue
  

Each option lists the most extensive procedure first, followed by the additional procedures with decreasing relative value units (RVUs). To decide which coding option is better you will need to know the payer allowables for each and what reduction, if any, the payer applies to the additional procedures. You would also have to be aware of any procedure bundles that are applied by your payer that might be different from those developed by Medicare. If you assumed this payer went by the Medicare relative value system and a 50% reduction for the second and third procedures (the “add-on” should not be discounted by the payer as it is valued based solely on the intraoperative portion for that procedure), the second option would be marginally better.

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.

Q I need CPT codes for the following surgical procedures performed on 1 patient on the same day: transvaginal hysterectomy, anterior pelvic floor reconstruction with Pelvicol graft tissue, posterior colporrhaphy, enterocele repair, and a bilateral vaginal vault suspension with the IVS tunneler system.

A This type of multifaceted surgery can be coded in several different ways, but you need to be aware of the relative value combinations you may come up with for the different options and the reduction that is applied by the payer when more than 2 procedures are reported on 1 patient on the same day.

You have 2 coding options here:

• 58270—Vaginal hysterectomy with enterocele repair
  
• 57260-51—Anterior and posterior (A&P) repair
  
• 57282-51—Vaginal vault suspension
  
• 57267—Pelvicol graft tissue (no modifier because this is a CPT “add-on” code)
  

or

• 58260—Vaginal hysterectomy
  
• 57265-51—A&P with enterocele repair
  
• 57282-51—Vaginal vault suspension
  
• 57267—Pelvicol graft tissue
  

Each option lists the most extensive procedure first, followed by the additional procedures with decreasing relative value units (RVUs). To decide which coding option is better you will need to know the payer allowables for each and what reduction, if any, the payer applies to the additional procedures. You would also have to be aware of any procedure bundles that are applied by your payer that might be different from those developed by Medicare. If you assumed this payer went by the Medicare relative value system and a 50% reduction for the second and third procedures (the “add-on” should not be discounted by the payer as it is valued based solely on the intraoperative portion for that procedure), the second option would be marginally better.

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.

Q I need CPT codes for the following surgical procedures performed on 1 patient on the same day: transvaginal hysterectomy, anterior pelvic floor reconstruction with Pelvicol graft tissue, posterior colporrhaphy, enterocele repair, and a bilateral vaginal vault suspension with the IVS tunneler system.

A This type of multifaceted surgery can be coded in several different ways, but you need to be aware of the relative value combinations you may come up with for the different options and the reduction that is applied by the payer when more than 2 procedures are reported on 1 patient on the same day.

You have 2 coding options here:

• 58270—Vaginal hysterectomy with enterocele repair
  
• 57260-51—Anterior and posterior (A&P) repair
  
• 57282-51—Vaginal vault suspension
  
• 57267—Pelvicol graft tissue (no modifier because this is a CPT “add-on” code)
  

or

• 58260—Vaginal hysterectomy
  
• 57265-51—A&P with enterocele repair
  
• 57282-51—Vaginal vault suspension
  
• 57267—Pelvicol graft tissue
  

Each option lists the most extensive procedure first, followed by the additional procedures with decreasing relative value units (RVUs). To decide which coding option is better you will need to know the payer allowables for each and what reduction, if any, the payer applies to the additional procedures. You would also have to be aware of any procedure bundles that are applied by your payer that might be different from those developed by Medicare. If you assumed this payer went by the Medicare relative value system and a 50% reduction for the second and third procedures (the “add-on” should not be discounted by the payer as it is valued based solely on the intraoperative portion for that procedure), the second option would be marginally better.

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.