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Ob-Gyn Coding Alert

More Codes Mean More Options for Reporting Colposcopies in 2003

From the Ob-Gyn Coding Alert
Extra Supplement on Endoscopic Procedures

CPT 2003's new colposcopy codes and reporting guidelines mean ob-gyn coders have to learn a whole new set of rules to ensure their practices receive appropriate reimbursement. Physicians' documentation will also need to be more specific when describing the colposcopy procedure they perform. With seven new codes and revisions to the remaining three from 2002, CPT 2003 redefines coding for colposcopy of the vulva, cervix and vagina. In addition, the new manual outlines several new reporting guidelines for the procedure. For 2003, the colposcopy codes include: 56820 Colposcopy of the vulva
56821 with biopsy(s)
57420 Colposcopy of the entire vagina, with cervix if present
57421 with biopsy(s)
57452* Colposcopy of the cervix including upper/adjacent vagina
57454* with biopsy(s) of the cervix and endocervical curettage
57455 with biopsy(s) of the cervix
57456 with endocervical curettage
57460 with loop electrode biopsy(s) of the cervix
57461 with loop electrode conization of the cervix. (For a detailed description of colposcopies and why ob-gyns perform them, please see aarticle 6.)

"I think these codes are very helpful to let the carriers know more precisely the extent of work done with each particular colposcopy, therefore maybe increasing reimbursement," says Maureen Murphy, CPC, a coding specialist at Mount Kisco Medical Group in Mount Kisco, N.Y. Coding Multiple Colposcopies When reporting colposcopies of multiple sites, CPT states, you should code for each procedure, adding modifier -51 (Multiple procedures) as appropriate. For example, if the ob-gyn performs colposcopies of the vulva and vagina, bill for both 56820 and 57420, appending modifier -51 to the code with a lesser relative value. (CMS has not set relative values for these codes as of this printing. You can check for the new relative values when they are released at CMS' Web site:

On the other hand, if the ob-gyn performs a superficial examination of the cervix with the colposcope, you should not report it separately from his or her examination of the entire vagina (57420 and 57421). Because the doctor's main interest when performing the procedure is the condition of the patient's vagina, his or her secondary look at the cervix is incidental. Similarly, if the physician uses the colposcope mainly to evaluate the cervix rather than the entire vagina, you should report only the cervical codes (57452-57461), says Jean Ryan-Niemackl, LPN, CPC, compliance analyst for QuadraMed, a multispecialty coding consulting firm in Fargo, N.D. For example, the ob-gyn performs a colposcopy after a patient's Pap smear returns with abnormal results. He finds an area of abnormal tissue at the cervix and biopsies it. He then examines the rest of the vagina, but it looks normal. When reporting this procedure, you [...]

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