Ob-Gyn Coding Alert

Question: I-m looking for a code for the following documentation: -Excision of mass of labia majora, avoiding the area of the clitoris. Specimen of fibrous soft tissue 4.2 cm x 2.3 cm x 1.0 cm sent for pathology.- Should I use 56620?


Virginia Subscriber

Answer: You should look for two things in your documentation:

- Did the ob-gyn remove a mass and suitable margins from the labia majora?
- Did the ob-gyn remove part of the labia that included the skin over the mass, the mucous membrane, and any superficial fat and connective tissue?

If your ob-gyn performed the first scenario, you should use the benign lesion excision codes 11420-11426, assuming the mass was not malignant.

If your ob-gyn performed the second scenario, you should use 56620 (Vulvectomy simple; partial) because this procedure is much more difficult.

CPT guidelines draw a fine line for this distinction. No matter which code you use, you-re likely to be correct. But the relative value unit difference is dramatic.

For example, if you use 11426 (Excision, benign lesion including margins, except skin tag [unless listed elsewhere], scalp, neck, hands, feet, genitalia; excised diameter over 4.0 cm), the RVUs for the inpatient setting are only 6.29. If the ob-gyn needed to do more than a simple closure of the remaining tissues (an intermediate or complex repair), you can also code for that using 12042 (Layer closure of wounds of neck, hands, feet and/or external genitalia; 2.6 cm to 7.5 cm), which has 4.39 RVUs, or 13132 (Repair, complex, forehead, cheeks, chin, mouth, neck, axillae, genitalia, hands and/or feet; 2.6 cm to 7.5 cm), which has 10.45 RVUs.
 
Compare these RVUs to the partial simple vulvectomy code (56620) with 13.14 RVUs, a procedure that would normally involve more than simple closure.

Bottom line: You should dig into the operative report, comparing probable procedure codes to CPT guidelines to determine which codes best match what your ob-gyn performed.

FYI: The classic definition of a simple vulvectomy is the removal of benign disease by the superficial removal of vulvar structures (such as labia minora, labia majora, clitoris, etc.), including the skin, mucous membrane, and any superficial fat and connective tissue. A simple partial vulvectomy, therefore, would be removing less than 80 percent of that vulvar area.