Ob-Gyn Coding Alert

Should you use 56620 or 15839 for labiaplasty? Experts explain.

Just because you won’t find a specific code for a 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.

Subscriber feedback: “My office has subscribed to the Ob-Gyn Coding Alert for many years and we find it a valuable resource. We would love to see an article about labiaplasty. We know there are two schools of thought on labiaplasty, billing 15839 or 56620. We are also aware that labiaplasty procedures vary greatly in the amount and depth of tissue removed. As an office, we are looking into more definitive coding guidelines for our practice. We would appreciate an article that offers factual coding guidelines for our reference,” says Karen A. from Oregon.

First, Get this Labiaplasty Background

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 Congress of Obstetricians and Gynecologists (ACOG). In addition, you should link the partial vulvectomy to a diagnosis in the 624 series, such as 624.3 (Hypertrophy of labia) in ICD-9 or N90.6 (Hypertrophy of labia) in ICD-10.

“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 21.11 facility relative value units (RVUs). On the other hand 56620 has 14.86 RVUs. Therefore, when you report 56620 you would be reimbursed $531.31. But if you bill for 15839, you would be paid approximately $754.78— approximately $223.47 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 your carriers. Be sure to check with your individual payers to determine which code you should use. Remember, if this procedure is considered cosmetic in nature by the payer, the chances for a denial are high no matter which code you use.