Learn 4 Tips to Fix Vulvar Lesion Coding Mistakes Before They Happen
Considering an integumentary code? Avoid making this $178 mistake. Do you know the difference between vulvectomy and vulvar lesion excision codes? The trick is that you need to examine the report and highlight these three elements: Why it matters: Check your relative value units (RVUs). All vulvectomies have more RVUs than lesion excisions because vulvectomies involve much more work. For instance, 56620 (Vulvectomy simple; partial) pays $573 while the most expensive of malignant lesion excision codes (11620-11626, Excision, malignant lesion including margins, scalp, neck, hands, feet, genitalia …) carries a $395 nonfacility allowable. That’s a difference of $178. Tip 1: Nondiscrete, Large Tissue Areas Mean Vulvectomy Code CPT® defines a simple vulvectomy as the removal of skin and superficial subcutaneous tissue. The classic definition of a simple vulvectomy is the removal of diseased tissue by the superficial removal of vulvar structures (such as labia minora, labia majora, clitoris, etc.), including the skin, mucous membrane, and any superficial fat and connective tissue. If the lesion is not discrete and involves large areas of tissue (such as extensive dysplasia), your ob-gyn will perform a vulvectomy, which you’d report with one of the following codes: When reporting a vulvectomy, you should watch for key terms. For instance, a complete radical vulvectomy includes excising the entire vulva and deep tissues, including the clitoris. A partial vulvectomy means the physician removes less than 80 percent of the vulva (for example, the left labia), but it can be a partial radical procedure, which means only part of the vulva is removed with the deep tissues. Tip 2: Lesion Size Means the Most for Integumentary Codes For lesions that are discrete and localized, however, you will look at the “Integumentary System” chapter of your CPT® code book — and not the “Female Genital System” chapter. Benign: You should report 11420-11426 (Excision, benign lesion including margins, except skin tag (unless listed elsewhere), scalp, neck, hands, feet, genitalia …) for the excision of discrete vulvar lesions, which require removal of only narrow surgical margins. What code you report depends on the lesion’s size — plus the margin removed. Malignant: Malignant lesions usually involve wide excisions. For these removals, you should report 11620-11626 (Excision, malignant lesion including margins, scalp, neck, hands, feet, genitalia …). Again, what code you report depends on the lesion’s size plus any margins. In some cases, when the ob-gyn cannot confirm a lesion as benign, but the ob-gyn still takes wide margins while removing the lesion, you still may report the malignant excision codes. Tip 3: You May Be Able to Report Layer Closure If your ob-gyn must do more than a simple closure of the remaining tissues (an intermediate or complex repair), you should add another code. You may report 12041-12047 (Repair, intermediate, wounds of neck, hands, feet and/or external genitalia …) or 13131-+13133 (Repair, complex, forehead, cheeks, chin, mouth, neck, axillae, genitalia, hands and/or feet …). The size of the lesion and that of the repair must match your ob-gyn’s documentation. Also, if a complex repair is 1.0 cm or less, CPT® instructs you to report the repair as intermediate, not complex. Tip 4: Don’t Overlook Dx Along with scrutinizing your ob-gyn’s documentation for lesion size, lesion margin, and layer closure, you should take note of the patient’s diagnosis. For instance, an infection (such as the human papilloma virus [HPV]) or irritant may cause vulvar dystrophy. For these conditions, ICD-10-CM offers the following codes: Did you know? If the pathology report returns with indications of dysplasia, the neoplasm is in transition from being benign to becoming malignant. If the process continues and the mass is left untreated, the neoplasm could eventually become malignant. Suzanne Burmeister, BA, MPhil, Medical Writer and Editor
