Wiki Chemical cauterization

[RABBIT2020]

Is there anyone here who may have the cpt assistant for the cpt 17250.
I would like to know what are the limitations to use this cpt.
Is is applicable to be used for any time the doctor addresses homeostasis to a scar or wound?
it has this " Excludes Chemical cauterization when applied for hemostasis of wound"
My supervisor thinks it should be used once silver nitrate is applied and used and is mentioned on the note.

 

[Cynthia Hughes]

CPT Professional edition has this instruction for 1750, (Do not report 17250 when chemical cauterization is used to achieve wound hemostasis). 17250 is a destruction code intended for destruction of proud flesh/granulation tissue.
Destruction means the ablation of benign, premalignant or malignant tissues by any method, with or without curettement, including local anesthesia, and not usually requiring closure.

In terms of repairing wounds, CPT states, Simple repair is used when the wound is superficial; eg, involving primarily epidermis or dermis, or subcutaneous tissues without significant involvement of deeper structures, and requires simple one layer closure. This includes local anesthesia and chemical or electrocauterization of wounds not closed. Form this, it is clear that chemical cauterization to stop bleeding is a part of a repair not a destruction.

I hope that helps.
Cindy

 

[csperoni]

17250 should be coded if the silver nitrate is used to remove granulation tissue, NOT to control bleeding. Control of the bleeding is included in the procedure code for excision or repair. So I would say it depends what you are doing with the silver nitrate, not just simply that it was used.

 

[RABBIT2020]

CPT Professional edition has this instruction for 1750, (Do not report 17250 when chemical cauterization is used to achieve wound hemostasis). 17250 is a destruction code intended for destruction of proud flesh/granulation tissue.
Destruction means the ablation of benign, premalignant or malignant tissues by any method, with or without curettement, including local anesthesia, and not usually requiring closure.

In terms of repairing wounds, CPT states, Simple repair is used when the wound is superficial; eg, involving primarily epidermis or dermis, or subcutaneous tissues without significant involvement of deeper structures, and requires simple one layer closure. This includes local anesthesia and chemical or electrocauterization of wounds not closed. Form this, it is clear that chemical cauterization to stop bleeding is a part of a repair not a destruction.

I hope that helps.
Cindy

I appreciate the response which clarifies the code description.

would you consider 17250 applicable here or 57061 or an E/M?

Gyn Exam: EXTERNAL GENITALIA: 2 cm area of granulation tissue noted at 7 o clock position Well healed second degree perineal laceration.

granulation tissue was gently grasped with a hemostat and removed with gentle traction. Pressure placed for hemostasis, and silver nitrate was applied to the remaining small amount of granulation tissue. Excellent hemostasis was noted and granulation tissue was sent to pathology.

 

[RABBIT2020]

17250 should be coded if the silver nitrate is used to remove granulation tissue, NOT to control bleeding. Control of the bleeding is included in the procedure code for excision or repair. So I would say it depends what you are doing with the silver nitrate, not just simply that it was used.

Thanks for your response.
would you consider this 17250 or just an E/M or 57061?

Gyn Exam: EXTERNAL GENITALIA: 2 cm area of granulation tissue noted at 7 o clock position Well healed second degree perineal laceration.

granulation tissue was gently grasped with a hemostat and removed with gentle traction. Pressure placed for hemostasis, and silver nitrate was applied to the remaining small amount of granulation tissue. Excellent hemostasis was noted and granulation tissue was sent to pathology

 

[csperoni]

To me, 57061 is the best option and what I would code.

I have seen cases where excision of vaginal granulation tissue is coded 11420-11426. In this case, since it was removed with hemostat and not truly excised and no closure, I would not code that here. I have also seen recommendation to use unlisted 58999 for excision of vaginal granulation tissue. I avoid unlisted if there is another reasonable option I can justify. On the accounts receivable end, unlisted codes are often time consuming and require a lot of additional work to get payment.

57061 The provider places the patient in the dorsal lithotomy position. The provider applies a local anesthetic to the vaginal mucosa. Once the provider identifies the location of the lesion, he destroys it by using laser surgery, electrosurgery, cryosurgery, or chemosurgery. For laser surgery, he vaporizes the lesion tissue using a high beam of light to kill the lesion or lesions. For electrosurgery, the provider uses a monopolar or bipolar instrument to destroy the lesion or lesions. In cryosurgery, the provider uses an instrument called a cryoprobe to apply liquid nitrogen to the lesion or lesions with repetitive freeze and thaw cycles performed. For chemosurgery, the provider applies a chemical to the lesion or lesions and then removes the destroyed tissue. The provider may also use monopolar surgery, where the current passes through the patient to complete the current cycle, or bipolar surgery, where the current only passes through the tissue between the two electrodes of the instrument.

17250 does not necessarily seem incorrect, but 57061 is more specific.

Based on the info provided, an E/M is definitely not appropriate. If there is further documentation not provided here, it is possible an E/M is also appropriate.

 

[RABBIT2020]

To me, 57061 is the best option and what I would code.

I have seen cases where excision of vaginal granulation tissue is coded 11420-11426. In this case, since it was removed with hemostat and not truly excised and no closure, I would not code that here. I have also seen recommendation to use unlisted 58999 for excision of vaginal granulation tissue. I avoid unlisted if there is another reasonable option I can justify. On the accounts receivable end, unlisted codes are often time consuming and require a lot of additional work to get payment.

57061 The provider places the patient in the dorsal lithotomy position. The provider applies a local anesthetic to the vaginal mucosa. Once the provider identifies the location of the lesion, he destroys it by using laser surgery, electrosurgery, cryosurgery, or chemosurgery. For laser surgery, he vaporizes the lesion tissue using a high beam of light to kill the lesion or lesions. For electrosurgery, the provider uses a monopolar or bipolar instrument to destroy the lesion or lesions. In cryosurgery, the provider uses an instrument called a cryoprobe to apply liquid nitrogen to the lesion or lesions with repetitive freeze and thaw cycles performed. For chemosurgery, the provider applies a chemical to the lesion or lesions and then removes the destroyed tissue. The provider may also use monopolar surgery, where the current passes through the patient to complete the current cycle, or bipolar surgery, where the current only passes through the tissue between the two electrodes of the instrument.

17250 does not necessarily seem incorrect, but 57061 is more specific.

Based on the info provided, an E/M is definitely not appropriate. If there is further documentation not provided here, it is possible an E/M is also appropriate.

I like your response.
Thats all the procedure note has. From the chart i can tell that the patient had delivered. Had a 6 weeks postpartum visit and is not back. It is not the vaginal mucosa it is the external vagina.
Its an in office procedure. I will query if any local anesthesia was applied. So thats the reason I am puzzled over the scenario.

Thank you kindly.

 

[csperoni]

OOOOOHHH - to be honest, I wasn't even considering that & didn't notice the external location since I've only encountered removing granulation tissue from the vaginal CUFF (post hysterectomy), which is definitely more internal than you have here. That is why I don't use 17250 (which is really a skin code). Taking into consideration this was not vaginal mucosa, then 57061 seems a lot less appropriate.

The vulva includes the labia majora, labia minora, mons pubis, bulb of the vestibule, vestibule of the vagina, greater and lesser vestibular glands, and vaginal orifice. The physician destroys one or more lesions of the vulva. After examination, the physician destroys lesions of the vulva by any method including laser surgery, electrosurgery, chemosurgery, or cryosurgery. Use 56501 to report single, simple lesion destruction, or 56515 to report multiple or complicated destruction of extensive vulvar lesions

If this is external genitalia (vulva), then 56501 for destruction of vulvar lesions may be your best option.

Again, 17250 does not seem wrong, but if there is a more specific code, then the more specific code should be used.

 

[Korbc]

OOOOOHHH - to be honest, I wasn't even considering that & didn't notice the external location since I've only encountered removing granulation tissue from the vaginal CUFF (post hysterectomy), which is definitely more internal than you have here. That is why I don't use 17250 (which is really a skin code). Taking into consideration this was not vaginal mucosa, then 57061 seems a lot less appropriate.

The vulva includes the labia majora, labia minora, mons pubis, bulb of the vestibule, vestibule of the vagina, greater and lesser vestibular glands, and vaginal orifice. The physician destroys one or more lesions of the vulva. After examination, the physician destroys lesions of the vulva by any method including laser surgery, electrosurgery, chemosurgery, or cryosurgery. Use 56501 to report single, simple lesion destruction, or 56515 to report multiple or complicated destruction of extensive vulvar lesions

If this is external genitalia (vulva), then 56501 for destruction of vulvar lesions may be your best option.

Again, 17250 does not seem wrong, but if there is a more specific code, then the more specific code should be used.

hey csperoni!
just wondering in a different thread you mention if silver nitrate is dabbed you used just an e/m, what would constitute 56501 vs just using an e/m for quick dabbing?

thanks!

 

[csperoni]

hey csperoni!
just wondering in a different thread you mention if silver nitrate is dabbed you used just an e/m, what would constitute 56501 vs just using an e/m for quick dabbing?

thanks!

Without knowing what that other thread was where I mention "silver nitrate is dabbed", I will make an educated guess.
In gyn, silver nitrate is often applied to stop some minor bleeding that may have occurred during speculum exam (for example friable cervix, vaginal stenosis, or vaginal atrophy), or following a biopsy.
56501 is for destruction of lesion(s), vulva; simple (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery)
What you are achieving with the silver nitrate leads you to the coding. I would refer to the specific medical records to determine which code to use in any specific situation.

 

[Korbc]

Without knowing what that other thread was where I mention "silver nitrate is dabbed", I will make an educated guess.
In gyn, silver nitrate is often applied to stop some minor bleeding that may have occurred during speculum exam (for example friable cervix, vaginal stenosis, or vaginal atrophy), or following a biopsy.
56501 is for destruction of lesion(s), vulva; simple (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery)
What you are achieving with the silver nitrate leads you to the coding. I would refer to the specific medical records to determine which code to use in any specific situation.

heyy
it was in this thread and your post was dated april 7th 2021 and it specifically referenced granulation tissue. in this link

https://www.aapc.com/discuss/threads/excision-of-granulation-tissue.179612/?view=date#post-541160

I'm a little confused by the question, but I don't agree with 13160 since this was not a closure and there was no dehiscence. Is the patient status post silver nitrate for excision of vaginal granulation tissue and now physician is excising additional granulation tissue with scissors (silver nitrate for hemostasis)?
Vaginal granulation tissue is typically at the vaginal cuff (internal). There is no code exactly for that and sometimes is very basic removal, other times can be rather extensive. The AUGS recommendation is unlisted 58999, and I think I've seen that elsewhere as well. https://www.augs.org/clinical-practice/archived-coding-questions/
What I have done is if it was very basic, and the doc just applied a little silver nitrate in 1 minute, I just bill the E/M.
If it needed to be more extensive, I then bill unlisted and ask it to be valued as 57105 or another similar code.

I just wanted to get this right. I know this was a difference example but you had said for vaginal granulation tissue if it's very basic you just use and e/m, at what point would you use just the e/m vs using code 57061 is what I'm wondering?

thank you so much!

 

[csperoni]

Ok - so it seems you are asking at what point does it become a separately billed procedure when you are destroying/removing vaginal granulation tissue at the vaginal cuff or destroying/removing vulvar granulation tissue (whether silver nitrate, forceps, hemostat, etc).
Unfortunately, there is no simple answer to that. I evaluate each case based on the documentation of the severity of the problem and the amount of work being done. I also factor in whether there was additional care provided besides destruction of vaginal granulation tissue. In this original post, there really was no E&M, so a procedure code would be the best answer.
1) It is not something I see very often - maybe once every 1-2 months between 5 gynonc clinicians. I don't recall ever seeing it from 3 obgyn providers.
2) When it is done, it is usually rather simple during an E&M and I would not recommend coding separately.
I honestly cannot recall the last time I billed out for one of these. A few times in my almost 20 years of gyn coding.

 

[Korbc]

Ok - so it seems you are asking at what point does it become a separately billed procedure when you are destroying/removing vaginal granulation tissue at the vaginal cuff or destroying/removing vulvar granulation tissue (whether silver nitrate, forceps, hemostat, etc).
Unfortunately, there is no simple answer to that. I evaluate each case based on the documentation of the severity of the problem and the amount of work being done. I also factor in whether there was additional care provided besides destruction of vaginal granulation tissue. In this original post, there really was no E&M, so a procedure code would be the best answer.
1) It is not something I see very often - maybe once every 1-2 months between 5 gynonc clinicians. I don't recall ever seeing it from 3 obgyn providers.
2) When it is done, it is usually rather simple during an E&M and I would not recommend coding separately.
I honestly cannot recall the last time I billed out for one of these. A few times in my almost 20 years of gyn coding.

Thanks! lately we've had quite a few cases of these lately, and full excision of granulation tissue, that's why I was asking We're the delivering provider for our local hospital and have 7 providers along with a few local tenums amongst aprn's and midwives.

 

[Korbc]

Ok - so it seems you are asking at what point does it become a separately billed procedure when you are destroying/removing vaginal granulation tissue at the vaginal cuff or destroying/removing vulvar granulation tissue (whether silver nitrate, forceps, hemostat, etc).
Unfortunately, there is no simple answer to that. I evaluate each case based on the documentation of the severity of the problem and the amount of work being done. I also factor in whether there was additional care provided besides destruction of vaginal granulation tissue. In this original post, there really was no E&M, so a procedure code would be the best answer.
1) It is not something I see very often - maybe once every 1-2 months between 5 gynonc clinicians. I don't recall ever seeing it from 3 obgyn providers.
2) When it is done, it is usually rather simple during an E&M and I would not recommend coding separately.
I honestly cannot recall the last time I billed out for one of these. A few times in my almost 20 years of gyn coding.

hey csperoni

Just to clarify on this again when it is done simply during an office visit with no other problems you recommend coding just the e/m right? not just the procedure correct? I wish I could find more online about when to charge for the procedure for simple application of silver nitrate vs charging just an e/m for it if done simple as well..... when does it go from just e/m to coding just the procedure....

thanks!

 

[natashalage]

I found additional information from ACOG 2020 that might be helpful for us:"
QUESTION: How should the destruction or removal of vaginal granulation tissue with silver nitrate cautery be reported?

ANSWER:

In general, the ACOG Coding Committee’s advice is that the performance of minimal physician work to destroy lesions is part of the evaluation and management (E/M) service. However, if the destruction required significant physician work, a procedure code for the destruction may be reported. Furthermore, if the physician performed and documented a significant E/M service—and the destruction required significant additional work that was also documented—both services can be reported.

Depending on the complexity of the procedure, either code 57061, Destruction of vaginal lesion(s); simple (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery), or 57065, Destruction of vaginal lesion(s); extensive (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery), may be used for reporting vaginal granulation tissue destruction. CPT defines destruction as “the ablation of benign, premalignant, or malignant tissues by any method, with or without curettement, including local anesthesia, and not usually requiring closure.”

It is incorrect to report code 17250, Chemical cauterization of granulation tissue (proud flesh, sinus or fistula), for the destruction of granulation tissue in the vagina. Per CPT guidance, procedure codes for destruction of lesion(s) in specific anatomic sites should be used instead.

It is worth noting that payer policies vary and some payers will not reimburse for E/M and procedures performed on the same encounter since most procedures are valued to include a minimal level of E/M service. Check with individual payers first for their accurate reimbursement policy."

 

[Korbc]

I found additional information from ACOG 2020 that might be helpful for us:"
QUESTION: How should the destruction or removal of vaginal granulation tissue with silver nitrate cautery be reported?

ANSWER:

In general, the ACOG Coding Committee’s advice is that the performance of minimal physician work to destroy lesions is part of the evaluation and management (E/M) service. However, if the destruction required significant physician work, a procedure code for the destruction may be reported. Furthermore, if the physician performed and documented a significant E/M service—and the destruction required significant additional work that was also documented—both services can be reported.

Depending on the complexity of the procedure, either code 57061, Destruction of vaginal lesion(s); simple (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery), or 57065, Destruction of vaginal lesion(s); extensive (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery), may be used for reporting vaginal granulation tissue destruction. CPT defines destruction as “the ablation of benign, premalignant, or malignant tissues by any method, with or without curettement, including local anesthesia, and not usually requiring closure.”

It is incorrect to report code 17250, Chemical cauterization of granulation tissue (proud flesh, sinus or fistula), for the destruction of granulation tissue in the vagina. Per CPT guidance, procedure codes for destruction of lesion(s) in specific anatomic sites should be used instead.

It is worth noting that payer policies vary and some payers will not reimburse for E/M and procedures performed on the same encounter since most procedures are valued to include a minimal level of E/M service. Check with individual payers first for their accurate reimbursement policy."

Thank you so much!!!