Part B Insider (Multispecialty) Coding Alert

Published on Tue Mar 28, 2006 PDF

New add-on code will make a difference to your denials

CPT made some changes to the way you should report endometrial biopsies in 2006. Read on to find out how to properly use new add-on code +58110 (Endometrial sampling [biopsy] performed in conjunction with colposcopy [list separately in addition to code for primary procedure]).

Example: The ob-gyn, when performing a colposcopy, wants to perform an endometrial biopsy in addition to any cervical or vaginal biopsy.

Old way: If you tried to report the endometrial biopsy code 58100 (Endometrial sampling [biopsy] with or without endocervical sampling [biopsy]...), most carriers would deny your claim. The National Correct Coding Initiative bundles this procedure with all colposcopy codes that include a vaginal or cervical biopsy (CPT 57421 , Colposcopy of the entire vagina, with cervix if present; with biopsy[s]; and colposcopy of the cervix codes 57454-57461).

New way: This year, "the new code, +58110, takes care of this problem because the resource-based relative value system (RBRVS) values this code for the intra-service work only," according to Melanie Witt, RN, CPC, MA, an independent coding consultant in Guadalupita, NM.

Bonus: When you receive your 2006 CPT book, you'll find that CPT added notes under colposcopy codes 57420 (Colposcopy of the entire vagina, with cervix if present), 57421 (...with biopsy[s]) and 57452-57461. These notes indicate that if the ob-gyn also performs an endometrial biopsy, you should report +58110 in addition to the colposcopy code. Remember that +58110 is an add-on code, so you don't need a modifier when you report this code with one of the other colposcopy codes.

Keep in mind: Because of +58110's addition, CPT has also revised 57421 to clarify that it represents only a biopsy of the vagina and/or cervix and not an endometrial biopsy. Now when you look at the descriptor of 57421, you'll see: "... biopsy[s] of vagina/cervix."