An ob-gyn doc with coding know-how tells us how to clean up our mesh claims.
Thinking of using +57267 (Insertion of mesh or other prosthesis for repair of pelvic floor defect …)? Given that +57267 can get you about $260 more, it’s a good move to consider for some claims — as long as you understand how to use it correctly.
The +57267 mesh add-on code is meant to capture “additional work for putting in mesh grafts where [mesh] is optional,” according to Dr. Harry Stuber, who spoke at an Ob-Gyn Specialty Coding & Billing Conference in Orlando. “If the procedure ALWAYS uses mesh (for example, sling, sacral colpopexy), it’s already been valued in the RVU. Don’t bill extra,” Dr. Stuber explains.
So when can you use +57267?
The answer is ‘NO’ for sling, sacral colpopexy.
But the answer is potentially ‘YES’ for anterior repair, posterior repair, paravaginal repair (that’s a new change), retrocele repair and hernia repair, incisional (use +57267 once for each site), Dr. Stuber says.
Medical necessity note: Don’t use cystocele or retrocele ICD-9 codes, Dr. Stuber warns. For weak fascia, consider 618.03 for pubocervical or 618.04 for rectovaginal. Tip: Make sure the physician has described fascia status in the op note.
Don’t miss the next Ob-Gyn Specialty Coding Conference in Orlando, this December 6-8.
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