Ob-Gyn Coding Alert

Bonus: Learn why you should forget about reporting ECC and biopsy in addition If you-re confused by loop electrode excision procedure (LEEP) codes, you-re not alone. The key to knowing the difference between a LEEP biopsy of the cervix and the conization of the cervix lies in your ob-gyn's documentation. Ask, -Did he remove part of the endocervix?- Not sure what the endocervix is? Our experts break down the anatomy, terminology, and your choice of LEEP coding options into relatable terms.
Take This Crash Course in Uterine/Cervical Anatomy In order to understand the conization of the cervix, you need to have a clear concept of the uterus and cervix and the sections therein. Get anatomical: The uterus and the cervix are not two different structures. The uterus is a muscular, pear-shaped organ with thick walls. The uterus has two portions: The top portion is above what is called the internal os or the isthmus, and that is the body of the uterus. The area below that internal os or isthmus is called the cervix. The cervix is sometimes referred to in the text and certainly in the CPT book as the -cervix uteri,- because it belongs to the uterus, says Melanie Witt, RN, CPC-OGS, MA, an independent coding consultant in Guadalupita, N.M. Focus on the cervix: The cervix has a several sections before it reaches that internal os. If you examine a diagram, you-ll see: an external opening, which opens directly into the vagina the transformation zone, which is inside the external os but right at the very edge of what ob-gyns will refer to as the -ectocervix- the -endocervix,- above that transformation zone up to the internal os. The endocervix is generally where physicians do an endocervical curettage (ECC), for instance. During a Pap smear, an ob-gyn will take the little brush and will actually go up into the endocervix, twirl it around and bring it back down.
Translate Anatomy Into LEEP Terms When an ob-gyn performs a biopsy of the cervix, the procedure will generally stay in the lower half and not go into the transformation zone. However, you have to pay particular attention to LEEP procedures. When LEEP is a biopsy: When the ob-gyn performs a LEEP biopsy, a machine that has an electric loop goes into the transformation zone and pulls up tissue from that area. In other words, as long as the machine stays right at that transformation zone, you should consider this a biopsy. When LEEP is conization: When the ob-gyn goes beyond the transformation zone and gets up into the endocervical canal, you-ll change to conization. The ob-gyn is taking a cone of the cervix out, and it has to include parts of [...]