Ob-Gyn Coding Alert

Question: I need some assistance with the following op note.

Diagnosis: Vulvar Condyloma

“The vulva was then thoroughly inspected.  The condyloma was limited to the left vulvar area at the introitus and did not extend into the vaginal canal. It was delineated using a marker. Using a scalpel, the entire condyloma was then removed in its entirety along the delineated line. No residual vulvar condyloma was noted after removal. The base was inspected and some oozing was cauterized using Bovie cautery. The vulvar incision was then repaired using individual sutures of #2-0 Vicryl, until complete closure was performed.”

The physician has turned in charges for a 56620 (Vulvectomy simple, partial). Is this correct?

Texas Subscriber

Answer: Because your physicianremoved a discrete lesion, you should report the integumentary lesion codes instead using one of the following codes:

• 11420,Excision, benign lesion including margins, except skin tag (unless listed elsewhere), scalp, neck, hands, feet, genitalia; lesion diameter 0.5 cm or less
  
• 11421, ... lesion diameter 0.6 to 1.0 cm
  
• 11422, …lesion diameter 1.1 to 2.0 cm
  
• 11423, …lesion diameter 2.1 to 3.0 cm
  
• 11424, …lesion diameter 3.1 to 4.0 cm
  
• 11426, …lesion diameter over 4.0 cm.
  

You’ll choose the correct code based on the size of the lesion plus margins excised.