Silver nitrate used for active bleeding of previous removed vaginal polyp (different visit)

[bpiper]

Topical administration of silver nitrate was used to what appeared to be base of a previously removed polyp within the vaginal wall with active bleeding. Insurance does not like CPT 97597. Of course CPT code 17250 is not appropriate since that is for granulation tissue. What other CPT code should be used?

 

[nielynco]

Topical administration of silver nitrate was used to what appeared to be base of a previously removed polyp within the vaginal wall with active bleeding. Insurance does not like CPT 97597. Of course CPT code 17250 is not appropriate since that is for granulation tissue. What other CPT code should be used?

First, 97597 could never be reported for this procedure as it is not debridement of necrotic tissue. In fact, the Medicare rules for this code state specifically CPT code 97597 requires the presence of devitalized tissue (necrotic cellular material). Secretions of any consistency do not meet this definition. The mere removal of secretions (cleansing of a wound) does not represent a debridement service. And of course as you point out, 17250 is also not an option. Code 57511 is also not an option. This code requires that the outer layers of the cervix be destroyed by freezing using a liquid such as carbon dioxide, freon, nitrous oxide, or nitrogen, or a low temperature instrument.

There is no specific code for chemical cautery of the cervix. This is because, normally, the procedure simply involves the application of a silver nitrate stick to the cervix, and does not require specialized equipment or expensive materials. If you think you can make a case for significant physician work in applying the silver nitrate, you can bill this as an unlisted procedure (58999). Otherwise, I would simply consider this incidental to the exam and bill only an evaluation and management service.