Ob-Gyn Coding Alert

Question: One of our patients has cervical dysplasia (622.1). Our ob-gyn performed a colposcopy, biopsy of vagina and cervix, and endocervical curettage (ECC). I was going to code this as 99214, 57452, 57500, 57100-51 and 57505. Is this correct?

Vermont Subscriber
 
Answer: Your suggested coding would be considered unbundling. And you should be aware of the new codes for colposcopy in CPT 2004 that include biopsies.
 
Keeping this in mind, you should report the colposcopy, cervical biopsy and ECC as 57454 (Colposcopy of the cervix including upper/adjacent vagina; with biopsy[s] of the cervix and endocervical curettage). CPT also notes that you can report 57421 (Colposcopy of the entire vagina, with cervix if present; with biopsy[s]) if the physician documents that he did the colposcopy exam of the entire vagina, not just the upper part. But the National Correct Coding Initiative (NCCI) bundles 57421 with 57454, and you cannot use a modifier to bypass the edit. If your carrier uses NCCI, your alternative will be to use 57100 (Biopsy of vaginal mucosa; simple [separate procedure]) as the second code for the vaginal biopsy.
 
Consequently, you can bill these procedures two potential ways. First, for carriers that do not use NCCI and when your ob-gyn has documented the second procedure, you would report 99214-25 (Office or other outpatient visit for the evaluation and management of an established patient ...; significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service), 57454 and 57421-51 (Multiple procedures). And for payers that use NCCI, you would code 99214-25, 57454 and 57100-59-51 (Distinct procedural service; multiple procedures) because NCCI bundles 57100 into 57454. But you can bypass the edit with modifier -59 (Distinct procedural service).

 - The answers for Reader Questions and You Be the Coder were provided by Melanie Witt, RN, CPC, MA, an ob-gyn coding expert based in Fredericksburg, Va.; and Harry L. Stuber, MD, an independent gynecologist based in Cookeville, Tenn.