# 17250 Chemical Cauterization of Granulation tissue



## clentz (Aug 16, 2011)

We are trying to bill out 17250 and the diagnosis is not matching procedure per the insurance company.  The diagnosis the doctor has indicated is 701.5 for (atrophic w granulation tissue along hymenal remnant from 6-8:00).  Can anyone help with a diagnos for this?  

Thanks!
Carlin


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## preserene (Aug 16, 2011)

I beg to disagree with the 17250 which belong to the integumentary system an di would suggest this hymen does not belong to the integumentary system.
 Also the diagnosis code of 701 belongs to the Skinand subcutaneous-integumentary system.

Hymen is at the lower end of vaginal canal and it is a *mucus membrane *made of non karatinized stratified squamous epithelium, like the vaginal mucosa.

[ Embroyonically, in the male the Müllerian ducts atrophy. In the female, the Müllerian ducts persist and undergo further development.The hymen represents the remains of the Müllerian eminence. The Müllerian ducts end in an epithelial elevation, the Müllerian eminence, on the ventral part of cloaca or urogenital sinus/sinovaginal bulb. The sinovaginal bulbs observed during development of the vagina, are infact the caudal segments of the Wolffian duct.This serve as a link between the Mullirean ducts and urogenital sinus.The hymen is a part and parcel of the tissues of the sinovaginal bulb(vaginal plate).
During the entire process, the lower wall of the vaginal canal remains intact, effectively shutting off the female reproductive sstem from the outside world. For some time after birth, this wall , *"THE HYMEN" * PERSISTS. it disintegrates at avariable point in time before onset of the first menis or reproductive cycle.].

So i feel we have to give adiagnosis code pertaining to the Vulval/Vaginal  mucosal laers or tissues- Hymenal remnants granulation-other specified inflam. diseases of the vagina and vulva *616.89 is the primary diagnosis*. If it is not payable, then I feel that you can support it  also with the billable diagnosis code 752.49; after all it is an embryonal remnant of the female genital system!! 
The cpt code I suggest that we would select either from 56501/56515, OR 57061 / 57065.
The chemical cuaterization is akind of Chemical Surgery, which destroys or the lesion. 
I would give merits to *vaginal than vulval for the reason I stated above.
*. 
But our CPT code places the hymen in the vulval codes.


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