Ob-Gyn Coding Alert

Question: My ob-gyn documented the following procedure: Excision granulation tissue vaginal cuff. Laparoscopy, extensive (45 minutes) lysis of adhesions of the sigmoid colon to posterior cul-de-sac. Scissors used to dissect lt. Uterosacral stitch out of peritoneum. Inspection revealed connection of the granulation tissue through the vagina into peritoneum. All granulation tissue was removed from vagina as well as inflammation and what appeared to be reaction to stitch. How should I report this?

Kentucky Subscriber

Answer: You should report the lysis of adhesions with 44180 (Laparoscopy, surgical, enterolysis [freeing of intestinal adhesion] [separate procedure]) and the removal of the granulation from the vaginal cuff (performed vaginally) as 58999 (Unlisted procedure, female genital system [nonobstetrical]).

When reporting an unlisted procedure code, you have to let the payer know how to judge that your charge is reasonable based on the physician work.

Better: Check with your surgeon to see what procedure he would like to compare this work to in order to set your fee. You should also let the payer know an equivalent of the approximate amount of work. To do this, review your physician's to note how the ob-gyn removed the granulation tissue.

If done by chemical cautery, you might compare the work to 17250 (Chemical cauterization of granulation tissue [proud flesh, sinus or fistula]). If done by destruction, say using a laser, by cryocautery you might compare the work to 57061 (Destruction of vaginal lesions[s]; simple [e.g., laser surgery, electrosurgery, cryosurgery, chemosurgery]) or 57065 (Destruction of vaginal lesion[s]; extensive [e.g., laser surgery, electrosurgery, cryosurgery, chemosurgery]). If he debrided the area, you might look to 11042 (Debridement, subcutaneous tissue [includes epidermis and dermis, if performed]; first 20 sq cm or less), and if he excised the tissue, you would need to know the extent of the area removed and look to 11440-11446 (Excision, other benign lesion including margins, except skin tag (unless listed elsewhere), face, ears, eyelids, nose, lips, mucous membrane ...) as a comparison, since the vaginal canal would be consistent with a mucus membrane..

Don't bother trying to code for the stitch removal, as this service seems to be part of the adhesions involvement.