Ob-Gyn Coding Alert

Question: Our ob-gyns routinely perform a cold knife cone biopsy followed by an endocervical curettage, which they send separately to pathology. I have been reporting this as 57520 and 57505-51, but the National Correct Coding Initiative (NCCI) bundles 57520 into 57505 as mutually exclusive. How should I report these procedures?

Florida Subscriber

Answer: NCCI bundles the endocervical curettage (57505, Endocervical curettage [not done as part of a dilation and curettage]) into conization (57520, Conization of cervix, with or without fulguration, with or without dilation and curettage, with or without repair; cold knife or laser) because the conization procedure removes all or part of the endocervix.

Under Medicare rules, if NCCI considers two codes as mutually exclusive, the payer will reimburse only for the lesser-valued code. Consequently, in this case, the carrier would pay 57505 and deny 57520.

Further, the number of specimens you submit to the lab does not affect your reimbursement. Although the carrier will pay the pathologist for his or her work on the various specimens, it will not reimburse the ob-gyn in most cases and especially not for an endocervical sample done at the time of conization, because it is part of the procedure by definition.