Ob-Gyn Coding Alert

Distinguish Between Destruction and Excision to Optimize Reimbursement

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

" 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 physicians 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
46924 destruction of lesion(s), anus (e.g., condyloma, papilloma, molluscum contagiosum, herpetic vesicle), extensive, any method
56501 destruction of lesion(s), vulva; simple, any method
56515 extensive, any method
57061 destruction of vaginal lesion(s); simple, any method
57065 ... extensive, any method

If multiple warts were destroyed from both the vulva and vagina, the destruction would be coded as 57065, 56515-51 (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 by any method, including laser, with or without surgical curettement, all benign or premalignant lesions (e.g., actinic keratoses) other than skin tags or cutaneous vascular proliferative lesions, including local anesthesia; first lesion

+17003 ... second through 14 lesions, each [...]

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