Ob-Gyn Coding Alert

Question: When we are billing for a colposcopy with biopsy, we are billing 56820 and 88305. For the tray, we are using A4550. We send the specimen for pathology out to be processed. Should append modifier 90 to that lab code?

California Subscriber

Answer: First of all, if your ob-gyn is performing a biopsy with the colposcope, the correct code is 56821 (Colposcopy of the vulva; with biopsy[s]), not 56820 (Colposcopy of the vulva). You should consider the taking of the biopsy as included in 56821. Therefore, you should not be billing 88305 (Level IV - Surgical pathology, gross and microscopic examination) -- unless your physician is personally doing the biopsy interpretation.

You should include A4550 (Surgical trays) in all procedures that you do in your office as part of an increased site of service payment (assuming the payer is recognizing relative value units [RVUs] in making payments).

You should not use modifier 90 (Reference [outside] laboratory) unless you are billing on behalf of the laboratory for biopsy interpretation. But remember you must use the CLIA number of the lab for which you are billing, and most insurances will not allow you to mark up the cost beyond what the lab is charging you.