Ob-Gyn Coding Alert

Question: Should I bill for a colposcopy using 57452* (Colposcopy [vaginoscopy]; [separate procedure]) and a vulvar biopsy using 56605* (Biopsy of vulva or perineum [separate procedure]; one lesion) with modifier -51 (Multiple procedures)?

Washington Subscriber

Answer: With the new CPT 2003 colposcopy codes, your question takes on a whole new meaning. If the ob-gyn uses the colposcopy to examine the vagina and takes a separate biopsy from the vulva without using the colposcope, you can bill for both procedures, but you should use the new code 57420 (Colposcopy of the entire vagina, with cervix if present) instead of 57452. If he or she uses the colposcope to visualize the vulva while also taking the biopsy, you should bill 57420 and the new code 56821 (Colposcopy of the vulva; with biopsy[s]).

The correct modifier to use will depend on the code combination you select. Code 56605 would take modifier -59 (Distinct procedural service) rather than modifier -51 because the biopsy is a CPT "separate procedures" that the payer might try to bundle with the colposcopy. The Medicare relative value units (RVUs) assigned to 56605 in 2002 are 3.11 if performed in the office. You should check the RVUs assigned to the new codes when they come out before billing the combination you have selected to make sure you list the highest-valued procedure first. For example, if you are billing 56605 and 57420, and 56605 has the lesser value, your claim should report the codes in this order: 57420, 56605-59-51. If the reverse is true, you should bill the procedures as 56605-59, 57420-51.