Ob-Gyn Coding Alert

Bonus: More than a simple closure may mean you can report a layer closure code, too. If you incorrectly report an integumentary code instead of a vulvectomy code, you could be costing your practice $200 -- or more. Choosing a vulvectomy versus a vulvar lesion excision code depends entirely on your ob-gyn's documentation. Look for: - type of lesion - lesion's size (plus margin) - layer closure. Check your relative value units (RVUs). All vulvectomies have more RVUs than lesion excisions because vulvectomies involve much more work, says Melanie Witt, RN, CPC-OBGYN, MA, an ob-gyn coding expert based in Guadalupita, N.M. For instance, 56620 (Vulvectomy simple; partial) pays $492.08 while the most expensive of malignant lesion excision codes (11620-11626, Excision, malignant lesion including margins, scalp, neck, hands, feet, genitalia -) carries a $260.13 facility charge. That's a difference of $231.95. Choose Vulvectomy For Non-Discrete, Large Tissue Areas If the lesion is not discrete and involves large areas of tissue (such as extensive dysplasia), your ob-gyn will perform a vulvectomy: - 56620 -- Vulvectomy simple; partial - 56625 -- - complete - 56630 -- Vulvectomy, radical, partial; - 56631 -- - with unilateral inguinofemoral lymphadenectomy - 56632 -- - with bilateral inguinofemoral lymphadenectomy - 56633 -- Vulvectomy, radical, complete; - 56634 -- - with unilateral inguinofemoral lymphadenectomy - 56637 -- - with bilateral inguinofemoral lymphadenectomy - 56640 -- Vulvectomy, radical, complete, with inguinofemoral, iliac, and pelvic lymphadenectomy Definition: 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 benign disease 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, Witt says. Key terms: When reporting a vulvectomy, you should watch for key terms. For instance, a radical vulvectomy, includes excising the skin and deep subcutaneous tissue. A partial vulvectomy means the physician removes less than 80 percent of the vulva (for example, the left labia). Focus on Lesion Size for Integumentary Codes For lesions that are discrete and localized, however, you will look at the "Integumentary System" chapter of your CPT 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 lesions usually involve wide excisions. For this, 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 [...]