Ob-Gyn Coding Alert

Should you use 56620 or 15839 for labiaplasty? Experts explain

Just because there's no code for labiaplasty doesn't mean you can't get paid for the procedure. But reporting the correct code may depend on why the ob-gyn performs the surgery.

If the patient has enlarged labia majora that interfere with daily activities, coitus and self-esteem, and the physician removes part of the labia, you should report 56620 (Vulvectomy, simple; partial), according to the American College of Obstetricians and Gynecologists (ACOG) February 2004 Practice Management and Coding Update produced by James Scroggs. In addition, he states that you should link the partial vulvectomy to a diagnosis in the 624 series, such as 624.3 (Hypertrophy of labia).

A simple partial vulvectomy may include removal of part or all of the labia majora and the labia minora on one side and the clitoris " ACOG states. "The underlying subcutaneous fatty tissue is removed along with the large portion of excised skin."

56620 Generally Means Lesions

According to the Coders' Desk Reference however you should report 56620 when "the physician removes part of the vulva to treat premalignant or malignant lesions." This implies that you should report 56620 only when the ob-gyn performs the labiaplasty because of a disease process. Generally enlarged labia majora alone do not indicate the presence of disease.

"The simple vulvectomy code was written originally I am sure for malignant or premalignant lesions " says Harry L. Stuber MD an independent gynecologist based in Cookeville Tenn.

Consequently some payers may deny a claim for labiaplasty when submitted as 56620 maintaining that you can report the code only when the ob-gyn performs the procedure to treat lesions or a similar medical condition.

15839 Doesn't Indicate Disease

Another option that may prove more effective is 15839 (Excision excessive skin and subcutaneous tissue [including lipectomy]; other area). As with 56620 15839 is not specific to labiaplasty but the excision code does not reference a disease process. Consequently 15839 may be more appropriate when the ob-gyn removes excessive labial tissue that is causing discomfort.

Fortunately choosing 15839 could boost your practice's bottom line. According to the Medicare Physician Fee Schedule 15839 has 18.33 nonfacility relative value units (RVUs). On the other hand 56620 has 13.40 RVUs. Therefore when you report 56620 you would be reimbursed roughly $500. But if you bill for 15839 you would be paid approximately $684 nearly $200 more.

In addition you may be able to append 15839 with modifier -50 (Bilateral procedure) if you perform the procedure on both sides Stuber says. Consequently "I would opt for the integumentary code as the way to go " he adds.

The final answer for coding this situation however rests with you carriers. Be sure to check with your individual payers to determine which code you should use.