Wiki Cervical Polyp Removal

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clovell

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Our OB/Gyn twisted off a cervical polyp with ring forceps and applied silver nitrate and sent for biopsy. Is there a separate procedure charge that accurately describes this service or is it just part of the E&M? The codes I considered all seemed to indicate there was some sort of cutting involved, which did not happen in this case.

Any assistance in coding this would be greatly appreciated!

Thank you!

Connie Lovell
 
There is no code that I am aware of either - I advise phyiscians to consider the time spent and work performed when choosing their E/M code.
 
Why not 57500? Isn't a polyp a lesion? In my Taber's a lesion is a tumor and a polyp is a tumor... Polyps usually form on/in mucousal organs/tissue, and I believe the cervix falls into that category.
 
The "small cut" is what was throwing me. Since the code reads biopsy of cervix OR local excision of lesion, is it appropriate to code based on the "biopsy of cervix" since the polyp was sent for biopsy?
 
I see where everyone is coming from, but I still disagree...the CPT Coding Reference states that "a speculum is inserted into the cervix, a small cut is made, and forceps are used to remove the tissue, bleeding may be stopped by electric current" to me if you are simply using forceps to twist and pull off a polyp you didn't do they same amount of work.
 
clovell said:
The "small cut" is what was throwing me. Since the code reads biopsy of cervix OR local excision of lesion, is it appropriate to code based on the "biopsy of cervix" since the polyp was sent for biopsy?
Click to expand...

I believe it is appropriate. Twisting the polyp off is going still going to create a "cut". I think we are getting hung up on the verbiage.
 
I also still think 57500 is appropriate. If you still disagree, add a -52 and take less payment for less work.
 
Keep in mind that each CPT code is valued both on physician time and equipment used. In the case of 57500, a cervical biopsy forceps or scalpel would have to be used and the typical time to do the actual removal is 15 minutes. Using ring forceps would not make this the same thing as a biopsy procedure as intended for 57500, whose purpose is to remove cervical tissue from the cervix using a cervical biopsy forceps (or a scalpel to cut off tissue). Sending the cyst for a biopsy after it is twisted off its stalk, is in my mind not the same thing as intended when 57500 was added to CPT.
 
IF there was a hysteroscope used to find the mass and the then mass was grasped with a single-toothed tenaculum and loop method was performed, would I code both 58555 and 57500? I have received a denial for using both codes as not separately payable. please advise
 
haygoodcas@bayviewphysicians.com said:
IF there was a hysteroscope used to find the mass and the then mass was grasped with a single-toothed tenaculum and loop method was performed, would I code both 58555 and 57500? I have received a denial for using both codes as not separately payable. please advise
Click to expand...
A hysteroscope examines the uterus, not the cervix. A cervix would more likely be examined with a colposcope.
Was the polyp of the cervix or of the uterus?
If the physician examined the uterus with a hysteroscope and removed a polyp of the uterus, there is one single code to describe this work.
58558 Hysteroscopy, surgical; with sampling (biopsy) of endometrium and/or polypectomy, with or without D & C
The codes you provided, 58555, 57500 are not NCCI edits, but do both have the separate procedure as part of the description. The clinical scenario seems unlikely, but if that is what was performed, I would appeal with records and ensure an appropriate diagnosis is linked to each CPT.
 
Thank you , I appealed with notes, Dr actually only used the Hysteroscope to visualize cervical mass. The mass was found when resecting the hysteroscope from the uterus. The hysteroscope was removed then the mass was removed by Loop electrode method and not through the hysteroscope. The mass was actually on the cervix
 
Hello,
I need some help with a related issue. Not sure if this would be 58558 or 58561 because it's different masses and not a "polyp or fibroid" also she uses a vaginoscope (colposcope i believe) and removes a polyp on the cervix but the removal is done with the myosure device so can i charge separate for it and since she used the vaginoscope charge a 57455 or would it just be a 57500?

thank you so much, please see below, and i was going to put mod 52 on it since she wasn't able to resect the mass all the way....

A speculum was placed, the cervix was very small and high in the vaginal vault. The Anterior lip was grasped with a tenaculum but even with traction the posterior lip and os were not well visualized. The anterior lip was injected with 1% lidocaine in a paracervical block, but the posterior lip could not be visualized well enough to inject it. The uterus was sounded somewhat blindly because the os was really not visualized but the sound eventually entered the cervix. The hysteroscope was unable to be inserted because the os could not be seen. The speculum was removed an vaginoscopy attempted. Eventually after several attempts the hysteroscope was inserted through the os and a cervical polyp was noted and resected with the myosure. The cervix was very long. The internal os was seen but the camera would not pass through. The camera was removed and the speculum replaced. After much manipulation the pratt dilator were finally able to be inserted through the cervix and the cervix gently dilated. The hysteroscope was inserted again after several attempts using vaginoscopy. The hysteroscope was able to be inserted into the endometrium. There was noted to be atrophic endometrium but a large, firm, endometrial mass. The myosure was used to resect the large mass. Behind it only one ostea was seen. It was then noted that the uterus was either bicornuate or contained a septum and the large mass had been in the right horn. The camera was then moved over to the left horn. There was a smaller mass up in the left cornua near the ostea. Some of it was removed with the myosure but not all could be reached as the camera could not reach all the way.
All instruments were removed. The cervix was hemostatic. The patient was awakened and transferred back to same day surgery in stable condition.
 
Korbc said:
Hello,
I need some help with a related issue. Not sure if this would be 58558 or 58561 because it's different masses and not a "polyp or fibroid" also she uses a vaginoscope (colposcope i believe) and removes a polyp on the cervix but the removal is done with the myosure device so can i charge separate for it and since she used the vaginoscope charge a 57455 or would it just be a 57500?

thank you so much, please see below, and i was going to put mod 52 on it since she wasn't able to resect the mass all the way....

A speculum was placed, the cervix was very small and high in the vaginal vault. The Anterior lip was grasped with a tenaculum but even with traction the posterior lip and os were not well visualized. The anterior lip was injected with 1% lidocaine in a paracervical block, but the posterior lip could not be visualized well enough to inject it. The uterus was sounded somewhat blindly because the os was really not visualized but the sound eventually entered the cervix. The hysteroscope was unable to be inserted because the os could not be seen. The speculum was removed an vaginoscopy attempted. Eventually after several attempts the hysteroscope was inserted through the os and a cervical polyp was noted and resected with the myosure. The cervix was very long. The internal os was seen but the camera would not pass through. The camera was removed and the speculum replaced. After much manipulation the pratt dilator were finally able to be inserted through the cervix and the cervix gently dilated. The hysteroscope was inserted again after several attempts using vaginoscopy. The hysteroscope was able to be inserted into the endometrium. There was noted to be atrophic endometrium but a large, firm, endometrial mass. The myosure was used to resect the large mass. Behind it only one ostea was seen. It was then noted that the uterus was either bicornuate or contained a septum and the large mass had been in the right horn. The camera was then moved over to the left horn. There was a smaller mass up in the left cornua near the ostea. Some of it was removed with the myosure but not all could be reached as the camera could not reach all the way.
All instruments were removed. The cervix was hemostatic. The patient was awakened and transferred back to same day surgery in stable condition.
Click to expand...
In my quick read of this, to me it seems the vaginoscope is being used to aide in the insertion of the hysteroscope due to the difficulty finding the os mentioned on the first attempt. I would not use a 52 modifier. A 52 modifier means at the physician's discretion a procedure was reduced. That is not the case here. Usually we hold these for path - if the mass was a fibroid then use 58561, and if not 58558.
 
Cmama12 said:
In my quick read of this, to me it seems the vaginoscope is being used to aide in the insertion of the hysteroscope due to the difficulty finding the os mentioned on the first attempt. I would not use a 52 modifier. A 52 modifier means at the physician's discretion a procedure was reduced. That is not the case here. Usually we hold these for path - if the mass was a fibroid then use 58561, and if not 58558.
Click to expand...
heyyy yeah my problems were it didn't discern weather it was a polyp or a fibroid and if it's just mass are there any rules that you have to automatically revert to 58558 just like when you code down to the lowest size because size is not documented (not applicable here just giving an example) I will query to. The other issue was that 58558 is for a uterine polyp should i used 57500 for the cervical polyp removal because it was on the cervix or should i used 58558 for the cervical polyp because even though it was not a polyp of the uterus it was removed hysterscopically and the only reason why i mention 52 is because when you read the end she couldn't get the entire mass in the left cornua because the camera couldn't reach all the way but i guess that part doesn't matter so much because she already already resected a large mass with it so the work is already done for the code so to speak because one was already fully resected.

do i used 57500 for the cervix polyp or 58558 since it was done with h'scope but wrong location, i would assume 57500? location trumps method i would believe......

and because she used a vaginoscopy which is not typical do i charge a colpo code with it

thanks!
 
Korbc said:
heyyy yeah my problems were it didn't discern weather it was a polyp or a fibroid and if it's just mass are there any rules that you have to automatically revert to 58558 just like when you code down to the lowest size because size is not documented (not applicable here just giving an example) I will query to. The other issue was that 58558 is for a uterine polyp should i used 57500 for the cervical polyp removal because it was on the cervix or should i used 58558 for the cervical polyp because even though it was not a polyp of the uterus it was removed hysterscopically and the only reason why i mention 52 is because when you read the end she couldn't get the entire mass in the left cornua because the camera couldn't reach all the way but i guess that part doesn't matter so much because she already already resected a large mass with it so the work is already done for the code so to speak because one was already fully resected.

do i used 57500 for the cervix polyp or 58558 since it was done with h'scope but wrong location, i would assume 57500? location trumps method i would believe......

and because she used a vaginoscopy which is not typical do i charge a colpo code with it

thanks!
Click to expand...
A vaginoscope is not the same this as a colopscope (and the cost for the vaginoscope is usually much less) so you are correct there is no colpo code that would fit this scenario for the removal of the cervical polyp. And I agree that the only reason to use the vaginosope was to be able to insert the hysteroscope so it would not be coded separately, but if time had been included as part of the op note to indicate how much longer it took to perform this procedure you might qualify for a modifier -22. The clinical vignette for 58558 includes an examination of the endocervical canal for lesions. Although the code does not go on to mention a cervical lesion in addition to possible endometrial lesions being sampled or removed, the interpretation by the payer could go with way. If you do not have a confirmed fibroid, your only choice for the lesions removal inside the uterus is 58558. You would not add a modifier -52 in this case because one lesion was removed and there is no requirement that more than one or even a complete lesion be removed to use this code. As to the cervical polyp, there is no code specific to removal via a hysteroscope so your only option is to bill 57500 as a additional code and see what happens. If you decided to try using a modifier -22, on the other hand, you would not bill separately for the cervical lesion, but count it as part of the additional significant work. The payer, of course, will have have last word on this.
 
nielynco said:
A vaginoscope is not the same this as a colopscope (and the cost for the vaginoscope is usually much less) so you are correct there is no colpo code that would fit this scenario for the removal of the cervical polyp. And I agree that the only reason to use the vaginosope was to be able to insert the hysteroscope so it would not be coded separately, but if time had been included as part of the op note to indicate how much longer it took to perform this procedure you might qualify for a modifier -22. The clinical vignette for 58558 includes an examination of the endocervical canal for lesions. Although the code does not go on to mention a cervical lesion in addition to possible endometrial lesions being sampled or removed, the interpretation by the payer could go with way. If you do not have a confirmed fibroid, your only choice for the lesions removal inside the uterus is 58558. You would not add a modifier -52 in this case because one lesion was removed and there is no requirement that more than one or even a complete lesion be removed to use this code. As to the cervical polyp, there is no code specific to removal via a hysteroscope so your only option is to bill 57500 as a additional code and see what happens. If you decided to try using a modifier -22, on the other hand, you would not bill separately for the cervical lesion, but count it as part of the additional significant work. The payer, of course, will have have last word on this.
Click to expand...
perfect, thank you so much! i had already coded to that advice except the vaginoscopy i had come across the poor advice that it's another term for a colposcope but now found other information that says it's not like you said in the index in the back of the optum obgyn coding companion it had the colpo codes under "vaginoscopy" which is what mainly threw me off

thank you so much!
 
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