Ob-Gyn Coding Alert

Questions: A patient undergoes a LEEP procedure in-office for cervical dysplasia. An endometrial biopsy is performed for post-menopausal bleeding (PMB). According to the CCI (Correct Coding Initiative), the endo dx is bundled into the LEEP. Because the LEEP is a major (90-day) procedure, I assume we cant charge an E/M level for the PMB with a modifier -25? Could we modify the endo with a -59 using the post-menopausal bleeding dx?

Cindy Cormier
Waterville Ob/Gyn

Answer: Code 58100* (endometrial sampling [biopsy] with or without endocervical sampling [biopsy], without cervical dilation, any method [separate procedure]) is a separate procedure which means it is not to be billed with another, more comprehensive procedure in the same body area. Taking that biopsy is considered incidental to the LEEP procedure.

Code 57522 (conization of cervix, with or without fulgaration, with or without dilation and curettage, with or without repair; loop electrode excision) has a 90-day global period. The E/M service should be billed with a -57 (decision for surgery) modifier if the decision to perform the surgery was made on that day.