Wiki excision of granulation tissue

rleif1sun

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patient presents s/p silver nitrate application for excision of vaginal granulation tissue. was excised with scissors. excision site was hemostatic with silver nitrate . what CPT code do i use for the excision?
 
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patient presents s/p silver nitrate application for excision of vaginal granulation tissue. was excised with scissors. excision site was hemostatic with silver nitrate . what CPT code do i use for the excision?


Check 13160. For packing or simple secondary wound closure, see 12020, 12021
 
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'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.
yes patient is status post silver nitrate and now presents for excision of vaginal granulation tissue
 
Since there is no code, and this was more that just dabbing silver nitrate, I would recommend unlisted 58999.
As with any unlisted code, be prepared to submit the op notes, and a letter explaining what was done and what code you are stating the work was similar to for reimbursement. Comparing to 57105 is an option or another code you feel would be similar work.
 
Since there is no code, and this was more that just dabbing silver nitrate, I would recommend unlisted 58999.
As with any unlisted code, be prepared to submit the op notes, and a letter explaining what was done and what code you are stating the work was similar to for reimbursement. Comparing to 57105 is an option or another code you feel would be similar work.
I have a similar case:

DX: N89.8 Vaginal Granulation Tissue

Area of granulation tissue was marked with a marking pen and injected with 0.25% marcaine with epinephrine. An elliptical incision was made with a 15 blade. The granulation tissue and underlying nodular/fibrosed scar tissue was removed and specimen sent for pathology. Vaginal epithelium was then re-approximated with 3-0 vicryl with several mattress sutures and simple interrupted sutures. Excellent hemostasis was observed.

In this case would you use 58999 and compare to the 57105?
57106 just does not make sense.
 
I have a similar case:

DX: N89.8 Vaginal Granulation Tissue

Area of granulation tissue was marked with a marking pen and injected with 0.25% marcaine with epinephrine. An elliptical incision was made with a 15 blade. The granulation tissue and underlying nodular/fibrosed scar tissue was removed and specimen sent for pathology. Vaginal epithelium was then re-approximated with 3-0 vicryl with several mattress sutures and simple interrupted sutures. Excellent hemostasis was observed.

In this case would you use 58999 and compare to the 57105?
57106 just does not make sense.
Yes, I would code this as 58999 unlisted since the specimen removed is granulation and scar tissue, not vaginal wall. 57105 could be a comparison, but you might say its 1.5 times the work, not just a straight 1:1 comparison, or another code that you feel is similar work.
 
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 agree 100% with your very precise reply.
 
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.
hey since silver nitrate counts as chemical cauterization couldn't you use 17250 for it?
 
hey since silver nitrate counts as chemical cauterization couldn't you use 17250 for it?
In this case, the clarification was the patient is status post (previously treated with) silver nitrate. Not receiving silver nitrate treatment today. So 17250 would definitely not be correct in this specific situation from the OP.
For education - https://www.aapc.com/discuss/threads/chemical-cauterization.176154/?view=date#post-481679 was a different scenario where silver nitrate treatment was given and a discussion of the coding options.
 
In this case, the clarification was the patient is status post (previously treated with) silver nitrate. Not receiving silver nitrate treatment today. So 17250 would definitely not be correct in this specific situation from the OP.
For education - https://www.aapc.com/discuss/threads/chemical-cauterization.176154/?view=date#post-481679 was a different scenario where silver nitrate treatment was given and a discussion of the coding options.
thanks so much! so helpful and would you think for granulation tissue in the vagina or vulva would icd L92.9 or N89.8 be more appropriate?
 
thanks so much! so helpful and would you think for granulation tissue in the vagina or vulva would icd L92.9 or N89.8 be more appropriate?
Since the location is specific to the vagina, I would report N89.8 as the most accurate code in this instance. The integumentary codes are primarily for conditions of the skin, hair, nails, etc (outside covering of the body). While the opening into the vagina is referred to as a "myocutaneous junction" and this term can apply to the integumentary system, if the granulation tissue is deep inside the vagina, the N diagnosis code would seem more appropriate.
 
Since the location is specific to the vagina, I would report N89.8 as the most accurate code in this instance. The integumentary codes are primarily for conditions of the skin, hair, nails, etc (outside covering of the body). While the opening into the vagina is referred to as a "myocutaneous junction" and this term can apply to the integumentary system, if the granulation tissue is deep inside the vagina, the N diagnosis code would seem more appropriate.
thanks!!
 
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