Ob-Gyn Coding Alert

ABCs of Biopsies A Diagnostic Coding Primer


- Published on Wed, May 01, 2002

Latest Question on CPT Code 58100 for Endometrial Biopsy from SuperCoder's Ask an Expert Forum

Question: A new patient comes in for excessive menses for 20 days. The ob-gyn discusses the options and orders blood work. The ob-gyn makes the decision to do a biopsy at this visit. I reported 99203-57 and 58100. My payer denied the E/M as bundled, but that doesn’t make sense. How would the ob-gyn know she was going to do a biopsy at this visit when the patient was new? Should I appeal?

Texas Subscriber

Answer: Yes, you should appeal the denial. Many times, you cannot make a case for an established...

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Coding for gynecological biopsies when performed as stand-alone procedures or in conjunction with other services constitutes significant revenue for many ob/gyn practices. Frequently, biopsies are done because of suspected malignancies but come back negative. This is good news for the patient but presents a coding problem when it comes to showing medical necessity. An understanding of the different types of biopsies, documentation requirements, and which ICD-9 codes need to be linked for proper reimbursement means fewer billing errors and more accurate reimbursement.

Reporting a justifying ICD-9 code is more important than ever before says Melanie Witt RN CPC MA an independent coding educator and ob/gyn coding expert because payers consistently look for close diagnostic matches before paying for expensive procedures. The payer is looking for a match between the procedure and reason for doing it and it is the payer who decides whether the code used justifies the procedure per their coverage policy " she says. In addition due to the many possible diagnoses and their often slight variations from one another coders must be particularly diligent in choosing the right ICD-9 code.

Biopsy Basics

Simply put a biopsy is a tissue sample that is excised from the patient to ascertain the presence of cancer. In the gynecological setting physicians are most likely to perform biopsies of the vulva cervix vagina endometrium and ovary(s). Biopsies can be ordered as a result of abnormal vaginal bleeding or after the detection of a mass cyst lump tumor or cells of abnormal appearance.

Endometrial Biopsy This procedure extracts samples from the tissue lining (endometrium) the inside of the uterus. A plastic catheter is inserted into the uterus and a small amount of the endometrial lining is suctioned out. The procedure is done vaginally either alone [...]

Ob-Gyn Coding Alert
Issue - May, 2002
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