Ob-Gyn Coding Alert

Question: A patient presented with a line of condylomata in the posterior fourchette, just inside the labia in the vagina. She also had a lesion just anterior to the urethral meatus. The ob-gyn vaporized both the lesion and condylomata using a CO2 laser. Additionally, the ob-gyn excised large-sized multiple condylomata around and into the rectum and sent them for diagnosis. He vaporized the remaining ones. After the excision and vaporization, the ob-gyn coated the area with Silvadene and the patient returned to recovery. How should I code for the lesions and excision?

Florida Subscriber

Answer: You should use two codes for the vaporization: 56515 (Destruction of lesion[s], vulva ...) for the lesions of the vulva (posterior fourchette and urethral meatus), and 46924 (Destruction of lesion[s], anus [e.g., condyloma, papilloma, molluscum contagiosum, herpetic vesicle], extensive [e.g., laser surgery, electrosurgery, cryosurgery, chemosurgery]) for the anal lesions.

For the excision, make sure you know the size of the lesion before you can report a benign (11400-11471) or malignant (11600-11646) skin code.

Reason: In this case, the "external genitalia" site applies as there is no code specific to the anus with regard to excision other than with anoscopy (46600, Anoscopy; diagnostic, with or without collection of specimen[s] by brushing or washing [separate procedure])).

-- The answers for Reader Questions provided by Melanie Witt, RN, CPC, COBGC, MA, an ob-gyn coding expert based in Guadalupita, N.M.