Gynecology surgery

When billing 57260 can I bill 56810 with a modifier of 59? The doctor does extensive work when doing 56810. Any help would be appreciated!

re: Gynecology surgery

As far as I can tell no these codes cannot be billed together, no modifier will help. It is the NCCI edits that will not allow it. You could try dropping the claim to paper with the 59 modifiers and file with notes showing the extensive work that was done.

re: Gynecology surgery

Bill 57260, 56810-59 NCCI allows the mod. If, the payer also goes by ACOG and they do not allow it then the mod will not help. Then only bill 56810-22

re: Gynecology surgery

Per Find-a-Code.com NCCI edits: Column 1 57260 and column 2 56810-0 Superscript 0 - Column 2 code will not be reimbursed, regardless of modifiers used. With this information it looks like 56810 will not be reimbursed even if there is a modifier on there.

I also did a little research online and there are several articles about this codes being billed together and the claim being denied as that are bundled together.

Good luck

Courtney

re: Gynecology surgery

Go on the CMS website and look up the current edits it's 1, which equals mod allowed. Sorry, I was looking at hospital edits instead of physician. Makes no sense why they are not the same. I say only bill 56810-22 send in with op.notes and hope for addt'l payment.

re: Gynecology surgery

here is what i have thru code correct...

Code / Description
57260 REPAIR OF VAGINA M Non-Facility RVU: 24.86


No bundling issues exist
56810 REPAIR OF PERINEUM M Non-Facility RVU: 7.76


Code 56810 is a component of Column 1 code 57260 and cannot be billed using any modifier.

re: Gynecology surgery

56810 is bundled with 57260 and no modifier is allowed for separate payment. the 56810 also has a separate procedure notation. This means that when this procedure is performed as an integral part of another procedure it is not reported. The lay description for 57260 also states that physician may perform perineorraphy (plastic repair) of the perineum. Hope this helps.

57260
Combined anteroposterior colporrhaphy;

Lay Description

The physician repairs both a cystocele and rectocele by colporrhaphy. Colporrhaphy involves a plastic repair of the vagina and the fibrous tissue separating the bladder, vagina, and rectum. A cystocele is a herniation of the bladder through its support tissues causing the anterior vaginal wall to bulge downward. A rectocele is a protrusion of part of the rectum through its support tissues causing the posterior vaginal wall to bulge. Using a combined vaginal approach and a posterior midline incision that includes the perineum and posterior vaginal wall, the physician dissects the tissues between the bladder, urethra, vagina, and rectum. The specific tissue weaknesses are repaired and strengthened using tissue transfer techniques and layered and plication suturing. The physician may also repair a urethrocele, which is a prolapse of the urethra, and perform a perineorrhaphy, which is a plastic repair of the perineum, including midline approximation of the levator and perineal muscles. The incisions are closed with sutures.