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TCA treatment for condyloma?

Susan Posted Fri 17th of February, 2017 12:45:52 PM
There seems to be conflicting information on how to bill for this. We used to bill 56501 for destruction of lesions, then years ago I was told this is only an office visit. TCA was not considered chemosurgery and 56501 did not apply. If patient is only seen for the TCA treatment-as in a follow up treatment- they can come every few weeks, the documentation doesn't always fit an E/M code. But billing 56501 can get very expensive. Can you please clear this up for me? Which view is correct?
SuperCoder Answered Mon 20th of February, 2017 00:54:49 AM

Yes there are conflicting views for using 56501 or E/M. But as per ACOG you should use destruction codes 56501 which has 10 day global period. 

If the ob-gyn destroys the lesion (for eg, by applying trichloroacetic acid (TCA) you should use the specific system codes-57501-56515, 57061—57065.
Report both the destruction or excision of the lesion and an E/M visit for a new or established patient (99201-99215) if an E/M service is separate and significant from the procedure
You should append modifier -25 (Significant, separately identifiable E/M service by the same physician on the same day of the procedure or other service) to the E/M code to indicate that the E/M service is separate from the lesion removal. On the other hand, if the ob-gyn prescribes a topical medication for the patient to apply at home, you should report only the E/M visit.

Thanks.

Susan Posted Tue 21st of February, 2017 16:45:38 PM
Are there documentation requirements for billing 56501 for TCA treatment. Sometimes all I get is "TCA applied to lesions, patient tolerated." Has ACOG always had this opinion, or was it CPT that said 56501 was not to be used for TCA?
SuperCoder Answered Thu 23rd of February, 2017 07:41:54 AM

For checking documentation requirement you can check your states LCD policy. Supercoder could not find any sources that states in CPT not to use code 56501 for TCA. Based on CPT’s definitions, if the ob-gyn destroys the lesion (for eg, by applying trichloroacetic acid (TCA) you should use the specific system codes-57501-56515, 57061,57065. 

Please check with your payer if they cover application of TCA under E/M service. Some payers may only reimburse an E/M service for topical application of trichloroacetic acid, TCA).

Hope that helps! Thanks.

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