51925 Closure of vesicouterine fistula; with hysterectomy

[ErnaV_2250]

Good day, please can I ask for guidance on the following coding:
51925 Closure of vesicouterine fistula; with hysterectomy
The code do not specify:
•Specify the type of hysterectomy: abdominal [58150-58294] / vaginal [58260-58294]/Lap hysterectomy [58541-58544]
•Do not include “with or without removal of tube(s), with or without removal of ovary(s)”
•Do not include grams [weight] in vaginal/ laparoscopic hysterectomy
Further to this I see that in the Procedure Desk reference this code provide detail that indicate it is as a matter of fact done laparoscopically. Thus a Laparoscope code listed in the middle of the Repair codes.

Procedure Desk Reference:
51925 When the patient is appropriately prepped and anesthetized the provider makes a small incision at the umbilicus, or navel, to insert a laparoscope. Under laparoscopic visualization, he identifies the vesicouterine fistula. He then uses a surgical scissor to dissect the fistula from both ends, and the provider removes it. Now, he makes a suprapubic incision and dissects the uterus from the supporting muscles. He staples the blood vessels to control bleeding. Next, he separates the uterus and cervix from the surrounding pelvic tissues and removes them. Finally, he stops all bleeding and closes the incision by suturing the soft tissue in layers.

Questions:
1. Do one code the hysterectomy code as well as the 51925, to provide more detail for the hysterectomy?
2. Is code 51925 seen as open and laparoscopic? because it is listed under the open repair codes but in the Desk Reference indicate Laparoscopic use?
Regards
Erna

 

[Darcy]

Good day, please can I ask for guidance on the following coding:
51925 Closure of vesicouterine fistula; with hysterectomy
The code do not specify:
•Specify the type of hysterectomy: abdominal [58150-58294] / vaginal [58260-58294]/Lap hysterectomy [58541-58544]
•Do not include “with or without removal of tube(s), with or without removal of ovary(s)”
•Do not include grams [weight] in vaginal/ laparoscopic hysterectomy
Further to this I see that in the Procedure Desk reference this code provide detail that indicate it is as a matter of fact done laparoscopically. Thus a Laparoscope code listed in the middle of the Repair codes.

Procedure Desk Reference:
51925 When the patient is appropriately prepped and anesthetized the provider makes a small incision at the umbilicus, or navel, to insert a laparoscope. Under laparoscopic visualization, he identifies the vesicouterine fistula. He then uses a surgical scissor to dissect the fistula from both ends, and the provider removes it. Now, he makes a suprapubic incision and dissects the uterus from the supporting muscles. He staples the blood vessels to control bleeding. Next, he separates the uterus and cervix from the surrounding pelvic tissues and removes them. Finally, he stops all bleeding and closes the incision by suturing the soft tissue in layers.

Questions:
1. Do one code the hysterectomy code as well as the 51925, to provide more detail for the hysterectomy?
2. Is code 51925 seen as open and laparoscopic? because it is listed under the open repair codes but in the Desk Reference indicate Laparoscopic use?
Regards
Erna

To answer your questions:

1. Generally, you would not code a separate hysterectomy code in addition to 51925. Adding a separate hysterectomy code would be considered unbundling and could lead to improper billing.

2. In 51925, the vesicouterine fistula is closed and a hysterectomy is performed. The fistula is excised and the bladder wall defect is closed as described above. The abdominal hysterectomy is then performed. The infundibulopelvic and round ligaments are identified, suture ligated, and divided. The bladder is reflected away from the cervix. Uterine and cervical vessels are cross clamped, divided, and ligated. The vagina is incised and the cervix separated from the vagina. The vaginal cuff is closed. The uterus and cervix are removed, bleeding controlled, and the abdominal incision closed in a layered fashion.

It's important to note that coding guidelines can change, and there may be specific circumstances or payer policies that could affect coding decisions. If you're dealing with a complex case or have any doubts, it's always best to consult with a certified coding specialist or refer to the most current coding guidelines and payer policies