Still having reservations about ablation

OBG Management. 2015 May;27(5):9-10

April 30, 2015|OBG Management

Letters from readers

“The vulvar lesion is visually identified, and its proximity to midline structures such as the clitoris, urethra, and/or anus is noted. A skin incision is made around the lesion including a 1 cm margin if a pre-invasive lesion is the indication. The excision includes epidermis, dermis, and superficial subcutaneous tissue. Hemostasis is obtained with cautery and/or suturing. The defect is then closed primarily in layers, with the first layer including subcutaneous fat and dermis, and the second layer including skin. Dressings are placed.”

The relative value units (RVUs) for this code are also fairly high at 14.86, and the procedure is designated as one that is performed in the hospital setting only. In addition, when valued, this procedure was assumed to represent 45 minutes of intraservice time (that is, the time for the actual surgery), and 56620 has a 90-day global period.

In contrast, 56515 (Destruction of lesion[s], vulva; extensive [eg, laser surgery, electrosurgery, cryosurgery, chemosurgery]) can be performed either in the facility or office setting and represents extensive destruction of tissue. In some cases, the physician may take a sample of tissue prior to the destruction, but this would be considered included in the destruction and not separately reportable, as the destruction represents the most extensive procedure. The clinical vignette used to value this code reads¹:

“The skin is prepped. Local anesthesia is injected. Destruction of multiple or extensive vulvar lesions is done via any method. Hemostasis is obtained.”

The RVUs for this procedure are less at 5.75 in the facility setting and 6.45 in the office setting, but the intraservice time is also less than with 56620.

Given your description of the procedure in this case, I would consider 56515 to be the most correct code to report for this surgery.

Reference
1. American Medical Association. RBRVS DataManager Online. AMA Store Web site. https://commerce.ama-assn.org/store/catalog/productDetail.jsp?product_id=prod280002&navAction =push. Accessed March 17, 2015.

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