Wiki Labiaplasty- 15839 vs 56620?

mmelough93

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Hi there.
Lately I've had a few cases where a provider is performing labiaplasty for hypertrophy or redundant tissue. I want to code as 15839 w dx N90.60 - however there have been a few providers who want to bill as 56620.

I seem to be finding conflicting information on this and wondering if anyone has any insight. There is a note in the aapc obgyn coder's specialty guide that states “Coders should use caution in reporting a simple partial vulvectomy for the removal of excess labial tissue (clinically referred to as labial hypertrophy) without the presence of a benign or premalignant condition. Most payers have a policy with regard to the removal of excess tissue and will reject a vulvectomy code with a dx of hypertrophy of the vulva. More appropriate coding for this condition would be 15839”. But there is also a CPT assist article from December 2013 that recommends 56620 for labial hypertrophy.

I have a scrubbed example of an op note I am working on now where the provider wants to bill as 56620- but im torn as I really dont feel it's appropriate in this scenario. Hoping someone can give me some insight on their answer to help better support my code choice:

(This particular procedure was done for both labial hypertrophy and left clitoral hood separated from labial minora post delivery)

The patient's labia minora were inspected and the area of redundant tissue was marked. She was prepped and draped in the standard fashion.

Attention was turned to the patient's right labia minora. The redundant tissue was injected with lidocaine with epi. Using a fine curved scissor the redundant tissue was excised. Areas of bleeding were then cauterized with the Bovie using a needlepoint tip. In a series of interrupted sutures using 4-0 Monocryl the labia was reconstructed. Good hemostasis was noted at the end of the procedure.

The same procedure was performed on the contralateral side. Along with the reduction labioplasty the area of separation of the clitoral hood from the labia minora was reattached. This was first done by injecting the area, removing the skin so the 2 raw edges could be reapproximated. The clitoral hood and labia minora were then reconstructed again using 4-0 Monocryl and multiple figure-of-eight's both externally and internally.

At the conclusion of the procedure the area was inspected there was minimal bleeding noted. A good cosmetic result was noted. The area was then dressed with a Vaseline impregnated gauze. The patient was then awoken from anesthesia and taken back to recovery room in stable condition.
 
Hi there.
Lately I've had a few cases where a provider is performing labiaplasty for hypertrophy or redundant tissue. I want to code as 15839 w dx N90.60 - however there have been a few providers who want to bill as 56620.

I seem to be finding conflicting information on this and wondering if anyone has any insight. There is a note in the aapc obgyn coder's specialty guide that states “Coders should use caution in reporting a simple partial vulvectomy for the removal of excess labial tissue (clinically referred to as labial hypertrophy) without the presence of a benign or premalignant condition. Most payers have a policy with regard to the removal of excess tissue and will reject a vulvectomy code with a dx of hypertrophy of the vulva. More appropriate coding for this condition would be 15839”. But there is also a CPT assist article from December 2013 that recommends 56620 for labial hypertrophy.

I have a scrubbed example of an op note I am working on now where the provider wants to bill as 56620- but im torn as I really dont feel it's appropriate in this scenario. Hoping someone can give me some insight on their answer to help better support my code choice:

(This particular procedure was done for both labial hypertrophy and left clitoral hood separated from labial minora post delivery)

The patient's labia minora were inspected and the area of redundant tissue was marked. She was prepped and draped in the standard fashion.

Attention was turned to the patient's right labia minora. The redundant tissue was injected with lidocaine with epi. Using a fine curved scissor the redundant tissue was excised. Areas of bleeding were then cauterized with the Bovie using a needlepoint tip. In a series of interrupted sutures using 4-0 Monocryl the labia was reconstructed. Good hemostasis was noted at the end of the procedure.

The same procedure was performed on the contralateral side. Along with the reduction labioplasty the area of separation of the clitoral hood from the labia minora was reattached. This was first done by injecting the area, removing the skin so the 2 raw edges could be reapproximated. The clitoral hood and labia minora were then reconstructed again using 4-0 Monocryl and multiple figure-of-eight's both externally and internally.

At the conclusion of the procedure the area was inspected there was minimal bleeding noted. A good cosmetic result was noted. The area was then dressed with a Vaseline impregnated gauze. The patient was then awoken from anesthesia and taken back to recovery room in stable condition.
I would go with the CPT Assistant article on this one, even if I disagree with it. You might be paid. Many insurers have been denying the 15839 code as "cosmetic" which may be why the CPT Assistant decided on the answer they settled on. However, this provider also did some work with the clitoral hood in a kind of reconstruction procedure for which there is no code either. So 56620 I think captures the amount of work performed.
 
I would go with the CPT Assistant article on this one, even if I disagree with it. You might be paid. Many insurers have been denying the 15839 code as "cosmetic" which may be why the CPT Assistant decided on the answer they settled on. However, this provider also did some work with the clitoral hood in a kind of reconstruction procedure for which there is no code either. So 56620 I think captures the amount of work performed.
thank you so much for your explanation. this is incredibly helpful!
 
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