Ob-Gyn Coding Alert

Question: When should we bill CPT^® code 17250 and CPT® code 57061? Is one of these codes more appropriate to bill for the following reason?

1. Silver Nitrate applied to the cervix due to bleeding2. Granulation tissue from surgical incision sites.

Illinois Subsciber

Answer: Code 17250 (Chemical cauterization of granulation tissue [proud flesh, sinus or fistula]) is an integumentary code, not a code for use on the internal GU structures. This means you could use this code for granulation tissue destruction on the perineum but not in the vaginal canal.

You should use CPT^® code 57061 (Destruction of vaginal lesion[s]; simple [eg, laser surgery, electrosurgery, cryosurgery, chemosurgery]) for destruction of a lesion in the vaginal canal that is done by applying laser, heat, cold or caustic chemicals. This code also represents a procedure that was valued based on the assumption of:

• 17 minutes of intraservice time with a total of 55 minutes of physician time (information from CPT^®’s RBRVS database) and
• whose supplies in the office include patient grounding pads for use of cautery equipment, needles, lidocaine, a vacuum pump and electrode cautery machine of at least 45 watts.

Beware: The RVU for this code in the office is 3.22, but CPT^® did not develop a clinical vignette or a description of the intraservice work. This is why most experts believe that simple use of silver nitrate sticks on granulation tissue in this location does not represent the work described by code 57061. In addition, dabbing silver nitrate on a cervix that is bleeding would also not qualify for use of 57061 since this is not a destruction of a vaginal lesion, but rather a cautery procedure. You have three codes that represent cautery of the cervix, but none of these codes (57510-57513) represent use of sliver nitrate sticks.

The code 17250 might be closer to the work performed, but the body area of the vaginal canal or cervix is not skin, so this code, while close, is still not accurate (and CPT^® has published that you should never report a procedure that is “close”). This code has 2.24 RVUs, and the CPT^® RBRVS database valued the code on about five minutes of intraservice time (or 17 minutes’ total time), and the basic supplies listed are a curette and silver nitrate sticks. There is a clinical vignette for this code which describes granulation tissue on the skin, and the intraservice work is described as follows: “Loose granulation tissue is gently curetted. The wound is irrigated with sterile saline. Silver nitrate sticks are applied to the granulation tissue. Hemostasis controlled.”

If you are using silver nitrate sticks to destroy granulation tissue in the vaginal canal, you should report 58999 (Unlisted procedure, female genital system [nonobstetrical]) and compare the work to 17250 (Chemical cauterization of granulation tissue [proud flesh, sinus or fistula]).