Simplify Cystocele Coding With These ICD-10-CM and CPT® Pointers

coding for urogynecology encounters

Urogynecology brings together urology and gynecology, specifically focusing on treating pelvic floor disorders. One diagnosis urogynecology coders need to be familiar with is cystocele, our topic for today.

Tie Your Diagnosis to These ICD-10-CM Codes

A cystocele occurs when the wall between the bladder and vagina weakens, causing a protrusion. You should report this condition using ICD-10-CM subcategory N81.1- (Cystocele). You have three codes to choose from in this subcategory:

  • N81.10 (Cystocele, unspecified)
    • Use this code when the only information you have is cystocele, prolapse of vaginal wall, or prolapse of anterior vaginal wall.
  • N81.11 (Cystocele, midline)
  • N81.12 (Cystocele, lateral)
    • This code is also appropriate for documentation of paravaginal cystocele.

Tip: If documentation shows urethrocele (prolapse of urethral mucosa) along with cystocele, use cystocele subcategory N81.1-. You should not additionally report N81.0 (Urethrocele).

But cystocele subcategory N81.1- is not appropriate for a patient with cystocele with prolapse of uterus (N81.2-N81.4).

You’ll find both of those rules in the ICD-10-CM tabular list with the codes.

Select CPT® Based on Procedure and Approach

Two procedures you may see to treat cystocele are anterior colporrhaphy and paravaginal defect repair.

Colporrhaphy is essentially suturing strong tissue together on either side of weak tissue to create a stronger wall. For anterior colporrhaphy, you should report 57240 (Anterior colporrhaphy, repair of cystocele with or without repair of urethrocele, including cystourethroscopy, when performed).

Note how the 57240 code descriptor covers repair of both cystocele and urethrocele, when the latter is performed.

For paravaginal defect repair, you need to know the approach to choose the correct AMA CPT® code:

  • Abdominal: 57284 (Paravaginal defect repair (including repair of cystocele, if performed); open abdominal approach)
  • Vaginal: 57285 (… vaginal approach)
    • This approach is a common one, and you may see it linked in particular to N81.12 for lateral cystocele.
  • Laparoscopic: 57423 (… laparoscopic approach).

One reason correct coding for these procedures is important is because of the difference in reimbursement on the Medicare Physician Fee Schedule (MPFS). The dollar amounts below are based on MPFS national rates (not adjusted for geography) for the first quarter of 2019:

  • Colporrhaphy, 57240: $612.66
  • Defect repair:
    • Abdominal approach, 57284: $841.15
    • Vaginal approach, 57285: $694.83
    • Laparoscopic approach, 57423: $941.34.

The difference between $612.66 for 57240 and $941.34 for 57423 is substantial, and coding errors will add up quickly in dollars if the providers in your practice perform these urogynecology procedures often.

What About You?

Do you code for urogynecology? What tips would you share with someone new to coding these services? How did you learn the definitions for the terms?

About 

Deborah works on a wide range of TCI SuperCoder projects, researching and writing about coding, as well as assisting with data updates and tool development for our online coding solutions. Since joining TCI in 2004, she’s covered the ins and outs of coding for radiology, cardiology, oncology and hematology, orthopedics, audiology, and more.

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