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Posted By Danielle Levy on 05-23-2019, 06:57:58 in Ob-Gyn
Please see attached question regarding insertion of mesh and offer any assistance
Comments (3)
Posted By Melanie Witt on 05-24-2019, 14:50:52
Recognizing that 57267 was specifically added to CPT to address surgical mesh, it probably still can be used if an allograft is used instead as the code describes surgical mesh or prosthesis and perhaps the payer will consider an allograft to be a prosthetic material. As to billing, you can either report 57267 X 2 for put it on 2 claim lines - this is highly payer dependent. But I repeat that the -59 modifier is not required when billed with an A&P repair.
Posted By Danielle Levy on 05-24-2019, 10:26:45
Regarding mesh, our MD explains in full detail the FDA mesh warning to the patient prior to procedure and dictates it in his op report as well and utilizes an allograft for the anterior colporrhaphy after native tissue is offered and declined . Would we still be able to bill 57267 ?
And when performed with A& P would we bill 2 line items with modifier (59) or use units x2?
Thanks again for you assistance
Posted By Melanie Witt on 05-23-2019, 15:52:14
First, you are aware that as of April 16, 2019 the U.S. Food and Drug Administration ordered the manufacturers of all remaining surgical mesh products indicated for the transvaginal repair of pelvic organ prolapse (POP) to stop selling and distributing their products in the U.S. immediately. This applies to the mesh your physician may be using and you will probably get a denial for 57267 by the commercial payers who have taken notice of this.
For the question you submitted, there are no bundling edits for 57265 and 57267 so a modifier -59 would not be used in any case and the 57267 would be grouped on the claim with 57265 to make that clear - and yes, you get to bill once for the use on the anterior wall and once on the posterior wall with accompanying diagnosis for each side. The information you received from AUGS is correct, if there is an enterocele repair at the time of a vaginal hysterectomy and you billed the code that includes vaginal hysterectomy with vaginal hysterectomy (58263, 58270, 58280, 58292, or 58294) you may not also bill 57283 as that code does repair an enterocele and you would be over coding.
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