Ob-Gyn Coding Alert

Answer: If the colposcopy is used to examine the vagina, you can bill for both procedures. If the colposcope was used to visualize the vulva only, you cannot bill for it because that is not what 57452 describes, and the use of the colposcope to view the skin would become an incidental procedure -- the method that was used to assist in doing the biopsy. The correct modifier to use is modifier -59 (distinct procedural service) rather than modifier -51 (multiple procedures) because both the colposcopy and the biopsy are CPT "separate procedures" that the payer might try to bundle when performed together. You can still use modifier -51 on the second listed procedure, but modifier -59 should be listed first and modifier -51 second (i.e., 56605, 57452-59-51). The code for the biopsy is listed first because it has a higher relative value than the vaginal colposcopy.