Ob-Gyn Coding Alert

The number of biopsy units doesn't always go by the number of samples

See how your answers measure up to the experts-.

Answer 1: The code for a laparoscopic ovarian biopsy is 49321 (Laparoscopy, surgical; with biopsy [single or multiple]). If the intraoperative biopsy reveals malignancy, the ob-gyn may convert to an open procedure to remove the ovary(ies) (for example, 58940, Oophorectomy, partial or total, unilateral or bilateral).

Note: You cannot report 58950 (Resection of ovarian, tubal or primary peritoneal malignancy with bilateral salpingo-oophorectomy and omentectomy) even though the results came back as a malignancy, because the ob-gyn did not perform an omentectomy.
 
At this point, most payers will consider the biopsy part of the more extensive procedure, but some may reimburse 49321 separately. If the work involved in performing the laparoscopy and obtaining the biopsy was significant and well documented, you may use modifier 22 (Unusual procedural services) appended onto 49321 to obtain higher reimbursement.

-It depends on the payer if they want it billed separately or if they want the extensive procedure with modifier 22,- says Denell Engstrom, CPC, a coding specialist at the Woman's Clinic in Boise, Idaho. -Either way, the ob-gyn did more work than just the open procedure and should be compensated.-

Don't forget: If the ovarian biopsy revealed malignancy, you-ll likely attach a diagnosis like malignant ovarian neoplasm (183.0) for 49321. Be careful though, Engstrom says: -You should never code malignant because the ob-gyn states it looks malignant without pathology confirming it.-
 
Entering the wrong diagnosis can have serious effects. You don't want to label a patient as having cancer if the diagnosis isn't certain, says Darren Carter, MD, president of Provistas Inc. in New York City. A cancer diagnosis is a red flag for insurers that could make gaining medical coverage more difficult for the patient.

Answer 2: This is an endometrial biopsy, so you should report 58100 (Endometrial sampling [biopsy] with or without endocervical sampling [biopsy], without cervical dilation, any method [separate procedure]). This code is a fairly straightforward procedure that an ob-gyn does in the office, without general or local anesthesia in most cases.

Keep in mind: You can report 58100 with a preventive or problem-oriented E/M visit by attaching modifier 25 (Significant, separately identifiable E/M service by the same physician on the same day of the procedure or other service) to the E/M code. If the patient reports for a biopsy and the ob-gyn planned or conducted no other service, however, you should report the biopsy code on its own.

New to 2006: If your ob-gyn performs an endometrial biopsy in addition to a colposcopy, you should use the new add-on code +58110 (Endometrial sampling [biopsy] performed in conjunction with colposcopy [list separately in addition to code for primary procedure]).

Answer 3: The CPT codes for vulva biopsy are 56605 (Biopsy of vulva or perineum [separate procedure]; one lesion) and +56606 (... each separate additional lesion [list separately in addition to code for primary procedure]).
 
Code 56606 is an add-on code, and its definition indicates that you can report it in multiples--in other words, for every lesion the ob-gyn excises after the first one. According to Engstrom, if the ob-gyn biopsies three separate lesions, the claim form would read, line by line:

- 56605
- 56606 x 2.

You should note that there is no modifier listed with 56606 because this code is an add-on one.

Heads up: You should not report all biopsies this way. In the case of a colposcopy and biopsy(s) of the cervix (57455, Colposcopy of the cervix including upper/adjacent vagina; with biopsy[s] of the cervix), you should only submit one code--even if the ob-gyn takes three samples in the same area.

The lab will bill for the three specimens it received, Engstrom says.