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Ob-Gyn Coding Alert

READER QUESTIONS:

Consider Condyloma of the Vulva Part of an E/M

Published on Tue May 03, 2005

Question: I know we should use E/M codes for TCA of the cervix, but which codes are more appropriate for condyloma of the vulva? Codes 17000 and 17003 (Destruction ...), or 56501 and 56515 (Destruction of lesion[s], vulva ...)?


Tennessee Subscriber


Answer: Neither choice is correct. CPT considers this an E/M service as well.

Trichloroacetic acid (TCA) is a caustic substance that ob-gyns use to destroy lesions and is more appropriately defined as "chemocautery" rather than "chemosurgery" (one of examples listed for destruction of lesions). The term "chemosurgery" indicates a technique in which a chemical is applied to malignant or diseased tissue and then surgically removed (like Moh's surgery).

The parenthetical note that goes with codes 17000-17999 says: "For initiation or follow-up care of topical chemotherapy (for example, 5-FU or similar agents), see appropriate office visits."

CPT means by this that if the ob-gyn paints 5-FU or TCA on the lesion, this service is considered an evaluation and management service (billing separately for the 5-FU or TCA), not a surgical procedure reported with codes 17000-17999 or 56501/56515. 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.
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