# TCA and E/M



## Karen A. (Aug 15, 2011)

I'm studying from the COBGC study guide. On page 46, the study guide states: per CPT, topical applications of chemo agents to destroy a lesion are reported as an E/M service [eg, TCA] Can anyone direct me to where in the CPT book this is stated?


----------



## preserene (Aug 15, 2011)

*trichloroacetic acid for application GYN*

Trichloracetic acid is chemical therapy for local application for destroying the lesions. 
The codes  are the 56501-56515- or 57061-57065 depending on genital site. ..are the ones I thought of.
But in the CPT manual it is not quoted any where as topical. The purpose of using these chemicals is to destroy the local lesions like whart or granulomas or any redundent tissues or small lesions.  If I am asked for an openion, I would go for those codes  I stated above, because they can be very well taken as chemical therapy for destruction of lesions-vulval, vaginal or cervical lesions.
The destruction of those lesions  have immediate effct too.
My  idea would be these codes combined with E/M services with -25 appended


----------



## preserene (Aug 15, 2011)

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.
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.


----------



## Karen A. (Aug 15, 2011)

thank you both! I will question information in the 2011 study guide.


----------

