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Ob-Gyn Coding Alert

Dig Up Reimbursement for Lesion Removal

" Because gynecological lesions can appear on several different female genital organs, apply the coding rules for removal from multiple sites to ethically optimize reimbursement. Lesions can be present on the vulva, vagina, cervix and anus, among other sites, and can be removed in one of two ways excision or destruction. When the ob-gyn excises a lesion, he or she cuts it away from the surrounding tissue and sends it for pathological examination, says Mary Mulholland, RN, BSN, CPC, a reimbursement analyst for the office of clinical documentation at the University of Pennsylvania's department of medicine in Philadelphia.

Destruction involves breaking down the lesion by any number of methods, including chemical and laser treatment, and electro- and cryosurgery. During cryosurgery, the physician freezes the lesion off using liquid nitrogen or carbon dioxide. The lesion is destroyed, and no biopsy is conducted. With routine and recurrent vaginal warts, the ob-gyn commonly uses a destruction method for removal. Consider Location, Number and Method for Destruction Several coding options exist for destruction of female genital lesions. Some coders may attempt to search the destruction codes (17000-17004), but you must consider many factors to determine the appropriate code the lesion(s) location, the number of lesions and the destruction method. The physician's operative note should clearly identify the size of the largest lesion, number and location, says Harry L. Stuber, MD, an independent gynecologist in Cookeville, Tenn. The codes for lesion destruction include the following: 46900* Destruction of lesion(s), anus (e.g., condyloma, papilloma, molluscum contagiosum, herpetic vesicle), simple; chemical
46910* electrodesiccation
46916 cryosurgery
46917 laser surgery
46922 surgical excision
46924 Destruction of lesion(s), anus (e.g., condyloma, papilloma, molluscum contagiosum, herpetic vesicle), extensive (e.g., laser surgery, electrosurgery, cryosurgery, chemosurgery)
56501 Destruction of lesion(s), vulva; simple (e.g., laser surgery, electro-surgery, cryosurgery, chemosurgery)
56515 extensive (e.g., laser surgery, electrosurgery, cryosurgery, chemosurgery)
57061 Destruction of vaginal lesion(s); simple (e.g., laser surgery, electro-surgery, cryosurgery, chemosurgery)
57065 extensive (e.g., laser surgery, electrosurgery, cryosurgery, chemosurgery) Note: Coders might be tempted to use codes from CPT's Destruction" Benign or Premalignant Lesions" section (17000 series). But you should use the codes for the anatomic site rather than the 17000 codes whenever possible CPT states. If the ob-gyn destroys multiple lesions on both the vulva and vagina you should use 57065 and 56515 appended with modifier -51 (Multiple procedures) Mulholland says. Also based on CPT's definitions if the ob-gyn destroys the lesion by applying trichloroacetic acid (TCA) you should use the above codes. The lesions' number and size define the difference between "simple" and "extensive." As a rule of thumb you should consider more than a few lesions as an "extensive" destruction Mulholland says. If the lesions are large [...]


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