Wiki Vulvar Resection Ulcer

Create Wiki Sort by date
B

bonnienorth55

Contributor
Messages
21
Best answers
0
Hi all, I have been going in circles with this procedure and would appreciate any help/advice! Our provider performed a "right vulvar resection" for a non-healing ulcer of the vulva. The body of the report reads:

"The labia was marked with a pen so that the entire non-healing ulcer could be resected. A large elliptical incision involving the entire ulcer as well as lateral labial tissue was created with the scalpel. The skin was elevated and the fatty tissue wedged out so that the skin could be brought together without tension. Bleeding controlled....deep tissue was re-approximated with 3-0 vicryl sutures, one from the top and the other from the inferior of the incision."

I thought a code from the 1142_ section would be best but no measurements were listed in the report. CPT 56620 comes up quite a bit in researching this procedure but it wasn't a "precancerous" or "cancerous" lesion....I was thinking I would request excised measurements from the provider in order to use a code from the 1142_ section but wanted to see if anyone else has advice/opinions. Thank you in advance :)
 
0
It seems like your provider performed a wide local excision. Depending on the reason for surgery, and the amount of tissue removed, you may be lead to 56620 vs 1142___.
In your example, I would choose from 1142___ as the provider removed a discrete area which was not precancerous or cancerous. I might consider 56620 if the ulcer plus margins was so large that a significant portion of vulva was excised.
You may need to query your clinician to amend the record to include the size of the excision (remember, code size of the excision, not just size of the lesion/ulcer.) A far less ideal alternative would be to check the size on the pathology report. As specimens sometimes shrink after excision, this is definitely only a last resort. I would also provide educational guidance to my provider about documentation of the size of excision for the future.
Minimal information regarding that, but worth mentioning if intermediate or complex closure is performed, that may be coded separately from 1142___.
I KNOW I had a link to an article that described this a bit more in depth, but I just can't seem to locate it now. I'll update my post if I find it.

I'm also going to add a caveat here. While I have extensive gynonc experience, I don't recall ever previously needing to code an ulcer removal. My 90 second research did not come up with any findings for ulcer removal codes. I am assuming the vulvar ulcer is considered a benign lesion. If anyone with experience in that area wishes to correct my interpretation, I will gladly accept the information.

I did find some related OB/GYN coding alerts from Codify that are related (but not addressing ulcers), but you may or may not be able to view, depending on your subscription:
 
0
Thank you so much for your response! I agree on querying the provider for the measurements. This was a tricky one with the limited amount of information. Thank you for those links as well, will be saving this for future reference :)
 
You must log in or register to reply here.
Top