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Many urologists have trouble finding the proper code for transvaginal urethrolysis because there is no code for it as an independent procedure. Urologists can get paid for urethrolysis following a sling procedure with 57287 and another for urethrolysis for scarring secondary to infection with 52285. If the urethrolysis follows a sling operation for stress incontinence, urologists should use 57287 (removal or revision of sling for stress incontinence [e.g., fascia or synthetic]), recommends Michael A. Ferragamo, MD, FACS, clinical assistant professor of urology at the State University of New York, Stonybrook. Code CPT 57287 is new for 2001. Previously, there was no specific code for sling removal or revision. Urethrolysis must sometimes be done after a sling operation because the sling may be too tight. The patient had urinary incontinence before the procedure, and then has urinary retention, which must be treated by releasing the sling and lysing the adhesions. The global period for the sling procedure itself (57288, sling operation for stress incontinence [e.g., fascia or synthetic]) is 90 days. The urethrolysis often takes place months after the sling operation, outside the global period, Ferragamo says. So modifier -78 (return to the operating room for a related procedure during the postoperative period) or -79 (unrelated procedure or service by the same physician during the postoperative period) would not be necessary. Urologists should, however, use modifier -52 (reduced services) to indicate that only part of 57287 was done the urethrolysis, and not the sling removal. Code 57287 is for the transvaginal approach. If using a suprapubic approach for urethrolysis, use 10120* (incision and removal of foreign body, subcutaneous tissues; simple) or 10121 (incision and removal of foreign body, subcutaneous tissues; complicated). If the urethrolysis is for previous scarring secondary to infection, use 52285 (cystourethroscopy for treatment of the female urethral syndrome with any or all of the following: urethral meatotomy, urethral dilation, internal urethrotomy, lysis of urethrovaginal septal fibrosis, lateral incisions of the bladder neck, and fulguration of polyp[s] of urethra, bladder neck, and/or trigone). Code 52285 does not adequately cover the dissection that is performed for the urethrolysis done subsequent to a sling procedure.
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