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Ob-Gyn Coding Alert

Distinguish Between Destruction and Excision to Optimize Reimbursement


- Published on Thu, Feb 01, 2001 Updated on Wed, Oct 01, 2014

Reviewed on May 20, 2015

 Genital warts, or lesions, is a common sexually transmitted disease (STD) and one that gynecologists treat through routine methods of removal. But when lesions are present in several different sites of the female genital organs, including the vulva, vagina and cervix, apply the coding rules for lesion removal from multiple sites to optimize reimbursement. Also, keep in mind the difference between destruction and excision when searching for the correct code.

 Genital warts and other gynecological lesions can be removed one of two ways through excision or destruction. When a lesion is excised, it is cut away from the surrounding tissue and sometimes biopsied. Destruction involves breaking down the lesion by any number of methods, including chemical and laser treatment, electro- and cryosurgery, during which the lesion is frozen off using liquid nitrogen or carbon dioxide. The tissue of the lesion is destroyed, and no biopsy is conducted. With routine and recurrent vaginal warts, destruction is the most common method of removal.

 There are several coding options for the destruction of lesions of the female genital areas. Some coders may be tempted to go directly to the destruction codes (17000-17004), but a number of factors go into determining which code to use the location of the lesion(s), the number of lesions and the destruction method. The physician’s operative note should clearly identify whether the lesions were on the vagina, vulva, other areas like the cervix or anus or in a number of areas simultaneously. The codes for destruction of lesions are:

 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 incision

 46924 destruction of lesion(s), anus (e.g., condyloma, papilloma, molluscum contagiosum, herpetic vesicle), extensive, (Update: (eg. Laser surgery, electrosurgery, cryosurgery, chemosurgery)

 56501 destruction of lesion(s), vulva; simple, (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery)

 56515 extensive, (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery)

 57061 destruction of vaginal lesion(s); simple (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery)

 57065 ... extensive, (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery)

If multiple warts were destroyed from both the vulva and vagina, the destruction would be coded as  56515, 57065-51, (multiple procedures). However, if the location of the warts is other than the vulva or vagina, and they are located on the skin and not the cervix, the inner thigh, or buttocks area for instance, choose from one of the following codes:

 17000 Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses); first lesion

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