How to Avoid a $233 Vulvectomy Coding Mistake

Fri, Mar 30, 2018 --

Coding Updates

Not sure whether to report an integumentary or vulvectomy code when your ob-gyn treats a patient for a vulvar lesion? If you select the wrong code, your practice could lose out on the money it rightfully deserves.

Did you know? Vulvectomies involve much more work and therefore have higher RVUs than lesion excisions. For instance, simple, partial vulvectomy code 56620 has 14.96 total facility RVUs (national). Compare that to only 8.47 total facility RVUs for top-dollar excision code 11626 (… excised diameter over 4.0 cm). Meaning, if you report 11626 in place of 56620, you could lose out on $233 of ethical pay.

Keep the pointers below in mind when you report vulvectomy or lesion excision so your practice is not deprived of its deserved reimbursement.

Which CPT® Codes to Use for Non-Discrete, Large Tissue Areas

Experts advise considering vulvectomy codes 56620-56640 when a lesion involves large areas of tissue a lesion that is not discrete.

Tip: When reporting a vulvectomy, watch for key terms. For example, a radical vulvectomy includes excising most or all of the skin/deep subcutaneous tissue. A simple vulvectomy involves superficial removal of vulvar structures for benign or premalignant disease. Mucous membrane, skin, and superficial fat and connective tissue may be involved.

When to Look to ‘Integumentary System’ Chapter

Use codes 11420-11426 from the “Integumentary System” chapter of your CPT® book for the excision of discrete, benign vulvar lesions, which require removal of only narrow surgical margins. Lesion size and the margin removed will affect your code choice.

Normally malignant lesions involve wide excisions, and you should use 11620-11626 to report excision of those lesions. Here, too, the code is determined by the size of the lesion and margins.

Don’t miss: If your ob-gyn performs intermediate or complex repair, add one more code when reporting the integumentary codes. Choose from 12041-12047 or 13131-13133, based on documentation and CPT® guidelines.

Diagnosis Coding Choices Do Matter

Take care when selecting diagnosis codes to support the procedure. For example, an infection or irritant may cause vulvar dysplasia; however, report vulvar dysplasia (N90.-), rather than the cause of the condition, to support the lesion removal.

Ease Your Day-to-Day Coding Challenges With Ob-Gyn Coder

Looking to decrease your ob-gyn claim denials while enhancing your reporting? Try TCI SuperCoder’s Ob-Gyn Coder, which adds the popular Ob-Gyn Coding Alert to code lookup and compliance tools. From coding tips for vulvar lesion procedures to every ICD-10 code for pregnancy, you’ll have all the information you need with a simple search.

What About You?

What do you watch for know whether to use an integumentary code instead of a vulvectomy?


Barnali is a medical coding and billing writer at TCI who has worked in the healthcare industry since 2009. She holds a master’s degree in English literature and a diploma in advertising and marketing. She enjoys writing about ICD-10 and Medicare compliance.

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